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DEREK PATRICK GONG M.D.
NPI 1184671513
Internal Medicine in Santa Rosa, CA

Active since May 30, 2006PECOS Enrolled
16319 THIRD STREET, SANTA ROSA, CA 95409(707) 869-2849(707) 869-1477 Get Directions Write a Review

NPPES record last updated: November 28, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Derek Patrick Gong M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEREK PATRICK GONG M.D. (NPI 1184671513) is an individual internal medicine provider in Santa Rosa, California, licensed in California (A66344) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1184671513
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDEREK PATRICK GONGCredential: M.D.
Location Address16319 THIRD STREETSanta Rosa, CA 95409
Mailing Address16319 Third StreetSanta Rosa, CA 95446 · (707) 869-2849 · Fax (707) 869-1477
Phone(707) 869-2849
Fax(707) 869-1477
Sole ProprietorNo
Enumeration DateMay 30, 2006
Last NPPES UpdateNovember 28, 2007
✔ NPI 1184671513 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in CA · A66344
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedPediatricsTaxonomy 208000000X · License A66344 (CA)
16319 THIRD STREET, Santa Rosa, CA 95409
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Other Identifiers 5

Medicare UPINH51477CA
Medicaid00A663440CA
Medicare OSCAR/certification551839CA
OtherZZZ73222ZCA · Group Ptan
MedicaidFHC03887FCA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Derek Patrick Gong M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Derek Gong reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Wound MD PC
19 mi
General Practice
2 BORAZON CT
Petaluma, CA 94952
  • Reassigned Medicare billing, California enrollment
  • 37 clinicians in this Medicare group
NPI 1942606744 (323) 800-2799
Permanente Medical Group Inc
48 mi
Internal Medicine
975 SERENO DRIVE
Vallejo, CA 94589
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1336222397 (707) 651-1000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95409 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$142.00 typical visit price
range $63.04 – $187.01
Typical copayment $35.50 (range $15.76 – $46.75)
Most-billed visit code 99204
Established Patient
$109.88 typical visit price
range $21.02 – $153.40
Typical copayment $27.47 (range $5.25 – $38.35)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derek Gong's NPI number?

The NPI number for Derek Gong is 1184671513. It was assigned to this individual provider in the NPPES registry on May 30, 2006.

Where is Derek Gong located?

Derek Gong practices at 16319 Third Street, Santa Rosa, CA 95409. The listed phone number is (707) 869-2849.

What is Derek Gong's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Derek Gong enrolled in Medicare?

Yes. Derek Gong is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Derek Gong's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Derek Gong reassigns Medicare benefits to 2 organizations: Wound MD PC (Petaluma, CA) and Permanente Medical Group Inc (Vallejo, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Derek Gong's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Derek Gong was last updated on November 28, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.