Ahmet Dervish, MD

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

33794 Issued in WI

Practice address

2845 Greenbrier Rd Ste 340
Green Bay, WI 54311-6519

Phone

(920) 288-8380

Fax

(920) 288-8385

NPI assigned

Jun 28, 2006

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

Other identifiers 3

Other names 1

• Ahmet Dervisogullari Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Baycare Clinic LLP

  • Emergency Medicine Physician
  • Green Bay, WI
  • NPI 1588609648
  Medicare reassignment NPD
• Baycare Clinic LLP

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1134490758
  NPD

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219968000000",
    "number": "1104854462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 GREENBRIER RD STE 340",
            "address_2": "PO BOX 8900",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543088900",
            "telephone_number": "920-288-8380",
            "fax_number": "920-288-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 GREENBRIER RD STE 340",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116519",
            "telephone_number": "920-288-8380",
            "fax_number": "920-288-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERVISH",
        "first_name": "AHMET",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2008-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "WI",
            "license": "33794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104365449",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "050080452",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32021400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AHMET",
            "last_name": "DERVISOGULLARI",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa A Dercks, APNP
• Danna Anne Derenne, APNP
• Ann T Derge, BSN, RN-C, APNP
• Dermatology Clinic S.C.
• Paul Herbert Dernehl, DDS
• Amy Des Forge, MS, LPC
• Ashley Desanctis, BCBA
• Heidi L Destree, MA
• Katrina Lynn Destree, M.D.
• Nathan Reid Deterville, PT, DPT

• Interventional Pain Medicine Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Interventional Pain Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.