DERRICK KYLE PELTON NP
NPI 1609208354
Nurse Practitioner - Family in Santa Rosa, CA

Q: What is Derrick Pelton's NPI number?

The NPI number for Derrick Pelton is 1609208354. It was assigned to this individual provider in the NPPES registry on August 5, 2013.

Q: What is Derrick Pelton's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Derrick Pelton was last updated on February 9, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since August 05, 2013PECOS EnrolledAccepts Medicare Assignment

3883 AIRWAY DR STE 120, SANTA ROSA, CA 95403(707) 521-4495(707) 573-5421 Get Directions Write a Review

NPPES record last updated: February 9, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 9, 2022, Jun 23, 2020 (2 updates tracked since 2020).

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About Derrick Kyle Pelton Np NPPES

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

DERRICK KYLE PELTON NP (NPI 1609208354) is an individual family provider in Santa Rosa, California, licensed in California (95012148) and active in the NPI registry since August 2013. He is enrolled in Medicare PECOS and is a graduate of Other (2013).

NPPES Registry Identity

NPI1609208354

Entity TypeIndividualMale

Primary Taxonomy363LF0000X

Provider Legal NameDERRICK KYLE PELTONCredential: NP

Location Address3883 AIRWAY DR STE 120Santa Rosa, CA 95403-1678

Mailing Address325 Distel CirLos Altos, CA 94022-1408 · (707) 521-4495 · Fax (707) 573-5421

Phone(707) 521-4495

Fax(707) 573-5421

Sole ProprietorNo

Medical School CMSOtherGraduated 2013

Enumeration DateAugust 5, 2013

Last NPPES UpdateFebruary 9, 20222 updates tracked since enumeration

NPPES CertifiedFebruary 9, 2022

✔ NPI 1609208354 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CA · 95012148

3883 AIRWAY DR STE 120, Santa Rosa, CA 95403

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Derrick Kyle Pelton Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6800030834

PECOS Enrollment IDI20191118000215

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

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

San Francisco Emergency Medical Associates

51 mi

Emergency Medicine

1101 VAN NESS AVE
San Francisco, CA 94109

Reassigned Medicare billing, California enrollment
155 clinicians in this Medicare group

NPI 1134110661 (415) 244-2886

Sutter Bay Medical Foundation

52 mi

Multi-Specialty

12 CAMINO ENCINAS
Orinda, CA 94563

Reassigned Medicare billing, California enrollment
4,479 clinicians in this Medicare group

NPI 1366898538 (510) 204-8180

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

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

431 services408 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

77 services77 patients

Automated urinalysis test 81003

An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.

73 services70 patients

Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) 87880

A detection test by immunoassay for Group A Strep is a quick procedure to identify a bacterial infection in your throat. It involves taking a throat swab and applying it to a test strip, which changes color if Strep bacteria are present.

33 services33 patients

Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen 87635

This is a lab test that detects the presence of COVID-19 in your body. It uses a technique to amplify the virus's genetic material, either DNA or RNA, making it easier to identify. A positive result indicates an active infection.

26 services26 patients

Detection test by multiplex amplified probe technique for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (covid-19), influenza virus types a and b, and respiratory syncytial virus 87637

This test identifies if you have COVID-19, influenza A or B, or respiratory syncytial virus. It uses a multiplex amplified probe technique, which amplifies and detects specific genetic material of the viruses, helping in accurate diagnosis.

24 services24 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95403 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

$96.16 typical visit price

range $63.04 – $187.01

Typical copayment $24.04 (range $15.76 – $46.75)

Most-billed visit code 99203

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.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. AMELIA RANDOLPH MD

Family Medicine