Derek Carl Bronson
Individual provider Active NPI Physician Assistant · Caldwell, ID
NPI 1962932343 · NPPES record last updated Dec 28, 2021
Key facts
- NPI
- 1962932343
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 1717 Arlington Ave
Caldwell, ID 83605-4802 - Phone
- (208) 459-4641
- NPI assigned
- Jun 18, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sacramento Ear Nose and Throat Surgical and Medical Group Inc
Vituity - Urgent Care Services PC
Eric L Ellis MD Inc
Practice addresses (Care Compare)
2 Medical Plaza Dr
Suite 225
Roseville, CA 95661-3044
Phone (916) 782-1291
4062 Flying C Rd
Suite 41
Cameron Park, CA 95682-9664
Phone (530) 676-8234
5007 Foothills Blvd
Roseville, CA 95747-6503
Phone (916) 727-6846
5290 Douglas Blvd
Granite Bay, CA 95746-6205
Phone (916) 258-2751
77 Lincoln Blvd
Suite 1
Lincoln, CA 95648-7422
Phone (916) 258-2751
Hospital & facility affiliations
- Sutter Roseville Medical Center
- Sutter Auburn Faith Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210902002018 | CA | Practitioner - Physician Assistant | 9436415700 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Permanente Medical Group, Inc | Current |
Accepting new patients | |
| Vituity - Urgent Care Services PC | Current |
Accepting new patients | |
| Sutter North Medical Foundation | Past | Accepting new patients |
Locations
4062 Flying C Rd
Ste 41
Cameron Park, CA 95682
Phone (530) 676-8234
1800 Harrison St
Fl 7
Oakland, CA 94612
3600 Broadway
Oakland, CA 94611
Phone (510) 752-6238
101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109
1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015
901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500
501 J St
Sacramento, CA 95814
Phone (916) 497-3000
2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000
710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400
5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700
7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000
975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000
Interoperability endpoints
- derek.bronson.1@20515.direct.athenahealth.com
- derek.bronson.1@11381.direct.athenahealth.com
- derek.bronson.1@19336.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
1717 Arlington Ave
Caldwell, ID 83605-4802
Mailing address
1800 Harrison St
FL 7
Oakland, CA 94612-3466
Phone (505) 620-0500
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Other providers in Caldwell, ID
- Trinidad Bridge
- Alexandria Blake Briggs
- Jared Britton
- Anne Brock
- Jason Eric Bromley
- Kayla Brooking
- Diane Marie Brown
- Matthew S Brown
- Sherri L Brown
- Gavin Bruderer
All providers in Caldwell, ID · Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.