Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jeremy Derickson, PA-C

Individual provider Physician Assistant · NPI 1821544503

Jeremy Derickson, PA-C is a Physician Assistant in Mesa, Arizona. Graduated from At Still University, Arizona School of Dentistry & Oral Hlth in 2016, 10 years ago. Practices with Brown Road Family Medicine, PLLC, a 6-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
10
Trained at
At Still University, Arizona School of Dentistry & Oral Hlth
Licensed in
AZ
In the registry since
2016
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

3720 E Pueblo Ave
Mesa, AZ 85206-1821
Phone: (928) 200-3526
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (AZ)

Record details

NPI number1821544503
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 31, 2016
Last updated in NPPESOctober 21, 2016

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolAT STILL UNIVERSITY, ARIZONA SCHOOL OF DENTISTRY & ORAL HLTH
Graduated 2016 (10 years in practice)
Group practice Brown Road Family Medicine, Pllc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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