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MR. DEREK KELLY COBURN P.A.
NPI 1861851784
Physician Assistant in Charlotte, NC

Active since February 19, 2016PECOS EnrolledAccepts Medicare Assignment
95.35/100
CMS Quality Rating
2001 VAIL AVE, CHARLOTTE, NC 28207(208) 863-8974 Get Directions Write a Review

NPPES record last updated: June 10, 2020. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jun 10, 2020, Feb 19, 2016 (2 updates tracked since 2016).

About Mr. Derek Kelly Coburn P.a. NPPES

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

MR. DEREK KELLY COBURN P.A. (NPI 1861851784) is an individual physician assistant in Charlotte, North Carolina, licensed in North Carolina (0010-06199) and active in the NPI registry since February 2016. He is enrolled in Medicare PECOS, is affiliated with Carolinas Medical Center/behav Health, and is a graduate of Other (2015).

NPPES Registry Identity

NPI1861851784
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. DEREK KELLY COBURNCredential: P.A.
Location Address2001 VAIL AVECharlotte, NC 28207-1248
Mailing Address3740 Wendwood Ln Apt 108Charlotte, NC 28211-1257 · (208) 863-8974
Phone(208) 863-8974
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateFebruary 19, 2016
Last NPPES UpdateJune 10, 20202 updates tracked since enumeration
NPPES CertifiedJune 10, 2020
✔ NPI 1861851784 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NC · 0010-06199
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Also ListedEmergency MedicineTaxonomy 207P00000X · License 001006199 (NC)
2001 VAIL AVE, Charlotte, NC 28207
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC, Oscar Health Plan of North Carolina, Inc.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Derek Kelly Coburn P.a. 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 ID840589438
PECOS Enrollment IDI20160520001862, I20201223001735
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.

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.

Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
111 services109 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
107 services105 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
99 services97 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010
A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
58 services52 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.
27 services27 patients
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.
15 services15 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Carolinas Medical Center/Behav Health

Acute Care Hospitals · Charlotte, NC
2/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number340113
Location1000 Blythe BlvdCharlotte, NC 28203 · Mecklenburg County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 28207 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
$83.90 typical visit price
range $54.12 – $165.09
Typical copayment $20.97 (range $13.53 – $41.27)
Most-billed visit code 99203
Established Patient
$67.72 typical visit price
range $17.21 – $134.61
Typical copayment $16.93 (range $4.30 – $33.65)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

95.35/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality84.22
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

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

LESLIE KAY RUFFING ADCOCK MD
Family Medicine
2001 VAIL AVE, STE 400
CHARLOTTE, NC 28207
Mecklenburg County (704) 304-7000
TAYLOR DEREK JOHNSON MD
Anesthesiology
2001 VAIL AVE
CHARLOTTE, NC 28207
Mecklenburg County (704) 304-5000
JENNIFER J CLINE PT
Physical Therapist
2001 VAIL AVE
CHARLOTTE, NC 28207
Mecklenburg County (704) 379-5837
VISHALAKSHI KALYANA SUNDARAM MD
Family Medicine
2001 VAIL AVE, STE 400
CHARLOTTE, NC 28207
Mecklenburg County (704) 304-7000
KRYSTENE LYNN HELGESON PA
Physician Assistant
2001 VAIL AVE
CHARLOTTE, NC 28207
Mecklenburg County (704) 304-6070
ESTHER REBECCA LANDIS HAYES MD
Family Medicine
2001 VAIL AVE, STE 400
CHARLOTTE, NC 28207
Mecklenburg County (704) 304-7000
SHENA S PATEL PT
Physical Therapist
2001 VAIL AVE
CHARLOTTE, NC 28207
Mecklenburg County (704) 379-5632
DUPAL PATEL MD
Family Medicine (Geriatric Medicine)
2001 VAIL AVE, STE 400
CHARLOTTE, NC 28207
Mecklenburg County (704) 304-7000

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 Coburn's NPI number?

The NPI number for Derek Coburn is 1861851784. It was assigned to this individual provider in the NPPES registry on February 19, 2016.

Where is Derek Coburn located?

Derek Coburn practices at 2001 Vail Ave, Charlotte, NC 28207. The listed phone number is (208) 863-8974.

What is Derek Coburn's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Derek Coburn enrolled in Medicare?

Yes. Derek Coburn is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Derek Coburn accept?

Health plans from Blue Cross and Blue Shield of NC and Oscar Health Plan of North Carolina, Inc list Derek Coburn as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Derek Coburn affiliated with any hospitals?

According to CMS data, Derek Coburn is affiliated with Carolinas Medical Center/Behav Health.

When was this NPI record last updated?

The NPPES record for Derek Coburn was last updated on June 10, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.