Derek Q Phan, MD is a medicare enrolled "Internal Medicine - Cardiovascular Disease" physician in Temescal Valley, California. His current practice location is
21634 Retreat Pkwy, Temescal Valley, California. You can reach out to his office (for appointments etc.) via phone at
(951) 493-6650.
Derek Q Phan is licensed to practice in Wisconsin (license number 100522) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1598184244.
Physician's Profile
| Full Name | Derek Q Phan |
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| Gender | Male |
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| Speciality | Internal Medicine - Cardiovascular Disease |
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| Location | 21634 Retreat Pkwy, Temescal Valley, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1598184244
- Provider Enumeration Date: 04/09/2014
- Last Update Date: 07/31/2023
Medicare PECOS Information:
- PECOS PAC ID: 1355612136
- Enrollment ID: I20180316001855
Medical Identifiers
Medical identifiers for Derek Q Phan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1598184244 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207R00000X | Internal Medicine | MD61123756 (Washington) | Secondary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | 0447579 (Kansas) | Secondary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | A138554 (California) | Secondary |
| 207RI0011X | Internal Medicine - Interventional Cardiology | 100522 (Wisconsin) | Secondary |
| 207RI0011X | Internal Medicine - Interventional Cardiology | MD61123756 (Washington) | Secondary |
| 207RI0011X | Internal Medicine - Interventional Cardiology | 0447579 (Kansas) | Secondary |
| 207RI0011X | Internal Medicine - Interventional Cardiology | A138554 (California) | Secondary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | 100522 (Wisconsin) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Derek Q Phan allows following entities to bill medicare on his behalf.
| Entity Name | Southern California Permanente Medical Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1770515280
PECOS PAC ID: 6002729175
Enrollment ID: O20031110000678 |
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| Entity Name | Riverside Medical Clinic Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1720183403
PECOS PAC ID: 2961492327
Enrollment ID: O20040517000880 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Derek Q Phan is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Derek Q Phan, MD
10798 Jurupa Rd, Po Box 136,
Jurupa Valley, CA 91752
Ph: (213) 569-1450 | Derek Q Phan, MD
21634 Retreat Pkwy,
Temescal Valley, CA 92883-6100
Ph: (951) 493-6650 |
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