NPIMap

Individual provider Active NPI

Derek E Clevidence, MD, PHD

  • Family Medicine Physician
  • Monona, WI
National Provider Identifier
1093774135
Registry record updated May 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
42305 Issued in WI
Practice address
6408 Copps Ave
Monona, WI 53716-3702
Phone
(608) 417-3000
Fax
(608) 417-3100
NPI assigned
Mar 18, 2006
Last updated
May 18, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 42305 WI Primary

Addresses

Primary practice location

6408 Copps Ave
Monona, WI 53716-3702

Mailing address

202 S Park St
Madison, WI 53715-1507
Phone (608) 417-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090824000159 WI Practitioner - Family Practice 1759435951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meriter Hospital IncGroup PAC ID 3971412735, 122 clinicians

Practice addresses (Care Compare)

100 Silverado Dr
Stoughton, WI 53589-5406
Phone (608) 417-8700

202 S Park St
Madison, WI 53715-1507
Phone (608) 417-6000

3102 Meriter Way
Madison, WI 53719-5833
Phone (608) 417-8800

6408 Copps Ave
Monona, WI 53716-3702
Phone (608) 417-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.59 of 100Reported as group
Quality
84.57
Promoting interoperability
91
Improvement activities
40
Cost
81.57

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Meriter Hospital, Inc. Current Accepting new patients
Meriter Hospital, Inc. CurrentSince Jan 1, 2015 Accepting new patients
Meriter Hospital, Inc. Past Accepting new patients

Locations

202 S Park St
Madison, WI 53715
Phone (608) 267-6000

3102 Meriter Way
Madison, WI 53719
Phone (608) 417-8800

6408 Copps Ave
Monona, WI 53716
Phone (608) 417-3000

Interoperability endpoints

  • Direct secure messaging: dclevidence263337@direct.unitypoint.org

Organizations & group practices 4

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526601600000",
    "number": "1093774135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151507",
            "telephone_number": "608-417-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6408 COPPS AVE",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537163702",
            "telephone_number": "608-417-3000",
            "fax_number": "608-417-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEVIDENCE",
        "first_name": "DEREK",
        "middle_name": "E",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2018-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "42305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monona, WI

Sources for this page

Verify at the official NPI Registry.