Derek S Poulson, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

AA103025 Issued in ME

Practice address

57809 Hillside Dr
Goshen, IN 46528-4402

Phone

(801) 623-7813

NPI assigned

Dec 8, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, CA2 enrollments

Enrollment records 2

Merit-based Incentive Payment System (MIPS)

Final score

63.31 of 100Reported as group

Quality

74.88

Improvement activities

0

Cost

73.76

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Greater Anesthesia Solutions

  • Anesthesiology Physician
  • Phoenix, AZ
  • NPI 1124430244

  AZ, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Valley Regional Anesthesia Associates Inc

  • Anesthesiology Physician
  • Fresno, CA
  • NPI 1578272415

  CA

  Medicare reassignment NPD
• North Gate Anesthesia PC

  • Certified Registered Nurse Anesthetist
  • Casa Grande, AZ
  • NPI 1073026464

  AZ

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384732800000",
    "number": "1033412440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57809 HILLSIDE DR",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465284402",
            "telephone_number": "801-623-7813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57809 HILLSIDE DR",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465284402",
            "telephone_number": "801-623-7813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSON",
        "first_name": "DEREK",
        "middle_name": "S",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-08",
        "last_updated": "2013-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ME",
            "license": "AA103025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Rebecca Pointon, MSN, RN, CNS, FNP
• Natasha Candace Pontius
• Poopalasingham Poovendran, MD
• Taylor Poppe
• Amanda Potter
• Marcia Ann Prenguber, ND
• Lauren Prescott
• Brittany Nicole Price, MSW, LSW
• Jeffrey Ellis Price, PHARMACIST
• Catherine Przybyla

• All providers in Goshen, IN
• Certified Registered Nurse Anesthetist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.