Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Derek Daniel Vanderburg, PA-C

Individual provider Physician Assistant · NPI 1922414598

Derek Daniel Vanderburg, PA-C is a Physician Assistant in Boise, Idaho. Qualified in 2014, 12 years ago. Works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Idaho and Minnesota.

Years since qualifying
12
Licensed in
ID, MN
In the registry since
2014
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

703 S Americana Blvd Ste 120
Boise, ID 83702-6754
Phone: (208) 706-2663
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 901 N Curtis Rd, Ste 501, Boise, ID 83706 — (208) 302-3900

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-1908 (ID)
Physician Assistant Taxonomy 363A00000X · Licence 11684 (MN)

Record details

NPI number1922414598
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 3, 2014
Last updated in NPPESNovember 8, 2022
Certification dateNovember 8, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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