NPIMap

Organization Active NPI

Derek S Weaver DO PLLC

Doing business as Weaver Family Medicine

  • Family Medicine Physician
  • Sunnyside, WA
National Provider Identifier
1982081485
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP60139736 Issued in WA
Legal business name
DEREK S WEAVER DO PLLC
Doing business as
Weaver Family Medicine
Practice address
2935 Allen Rd
Sunnyside, WA 98944-8931
Phone
(509) 837-0070
Fax
(509) 837-0690
NPI assigned
May 4, 2015
Last updated
Apr 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Derek S Weaver, DONPI 1962660704
Title
Physician/Owner
Phone
(509) 840-5132

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
Family Medicine Physician 207Q00000X OP60139736 WA Primary

Addresses

Primary practice location

2935 Allen Rd
Sunnyside, WA 98944-8931

Mailing address

2935 Allen Rd
Sunnyside, WA 98944-8931
Phone (509) 837-0070

Other identifiers 1

IdentifierTypeStateIssuer
2045212MedicaidWA

Other names 1

  • Weaver Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160202000515 WA Part B Supplier - Clinic/Group Practice 8123322716 Receives reassigned benefits from 9 practitioners
Practice locations: Sunnyside, WA
O20160229003053 WA Part A Provider - Rural Health Clinic 8123322716 Practice locations: Sunnyside, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982081485. Details of each certification follow.

Rural health clinic certification: CCN 503923

Legal name
DEREK S WEAVER DO PLLC
Doing business as
WEAVER FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 30, 2016
Last certification
Mar 30, 2016
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Apr 20, 2015 in WA
Enrollment address
2935 Allen Rd
Sunnyside, WA 98944-8931

National Provider Directory

National Provider Directory

Locations

2935 Allen Rd
Sunnyside, WA 98944
Phone (509) 837-0070

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Derek S Weaver Individual 5% Or Greater Direct Ownership InterestOwner Apr 20, 2015 100%
Corporate Officer Apr 20, 2015 100%
W-2 Managing Employee Apr 20, 2015 100%
Operational/Managerial Control Apr 20, 2015 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Derek Samuel Weaver, DO
    • Family Medicine Physician
    • Sunnyside, WA
    • NPI 1962660704

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776211200000",
    "number": "1982081485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2935 ALLEN RD",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989448931",
            "telephone_number": "509-837-0070",
            "fax_number": "509-837-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2935 ALLEN RD",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989448931",
            "telephone_number": "509-837-0070",
            "fax_number": "509-837-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK S WEAVER DO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-04",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "509-840-5132",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP60139736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2045212",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Weaver Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sunnyside, WA

Sources for this page

Verify at the official NPI Registry.