NPIMap

Individual provider Active NPI

Derek Anthony McLister, D.P.M

  • Podiatrist
  • Fargo, ND
National Provider Identifier
1114453552
Registry record updated Apr 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
1068 Issued in MN
Practice address
5225 23Rd Ave S
Fargo, ND 58104-7927
Phone
(701) 417-2575
NPI assigned
May 4, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X 86 ND
Student in an Organized Health Care Education/Training Program 390200000X ND
Podiatrist 213E00000X 1068 MN Primary

Addresses

Primary practice location

5225 23Rd Ave S
Fargo, ND 58104-7927

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dmclister9912504@direct.sanfordhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200910003348 ND Practitioner - Podiatry 9032537873 Reassigns benefits to 1 organization
I20201002001836 MN Practitioner - Podiatry 9032537873 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians
Sanford Health Network NorthGroup PAC ID 8022206663, shared by 16 NPIs, 114 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

1720 Hwy 59 S
Thief River Falls, MN 56701-4331
Phone (218) 681-4747

1720 University Dr S
Fargo, ND 58103-4940
Phone (701) 234-2000

2400 32ND Ave S
Fargo, ND 58103-5800
Phone (701) 234-2000

3001 Sanford Pkwy
Thief River Falls, MN 56701-2700
Phone (218) 683-2725

5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2575

Hospital & facility affiliations

  • Sanford Medical Center Fargo Hospital, Fargo, ND, CCN 350011
  • Sanford Thief River Falls Medical Center Hospital, Thief River Falls, MN, CCN 241381
  • Essentia Health Hospital, Fargo, ND, CCN 350070

Merit-based Incentive Payment System (MIPS)

Final score
90.22 of 100Reported as group
Quality
90.28
Promoting interoperability
100
Improvement activities
40
Cost
72.7

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue13
Removal of nail tissue65
Removal or shaving of skin growth21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
86NDMDOrthopaedic Foot and Ankle Surgery Physician
1068MNMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health Network North Current Accepting new patients
Sanford Health Network North CurrentSince Aug 20, 2020 Accepting new patients
Sanford Medical Center Fargo CurrentSince Aug 10, 2020 Accepting new patients
Sanford Health Network North CurrentSince Aug 20, 2020 Accepting new patients
Sanford Medical Center Fargo Foot and Ankle Surgery CurrentSince Aug 10, 2020 Accepting new patients
Sanford Health Network North Current Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients
Sanford Health Network North Past Accepting new patients

Locations

1720 US Highway 59 SE
Thief Rvr Fls, MN 56701
Phone (218) 681-4747

3001 Sanford Pkwy
Thief Rvr Fls, MN 56701
Phone (218) 681-4240

5225 23rd Ave S
Fargo, ND 58104
Phone (701) 234-5933

1720 University Dr S
Fargo, ND 58103
Phone (701) 280-4140

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 8

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.

Hospital & facility affiliations 9

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": "1493856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1114453552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 23RD AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047927",
            "telephone_number": "701-417-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLISTER",
        "first_name": "DEREK",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.P.M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-04",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "ND",
            "license": "86",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ND",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MN",
            "license": "1068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmclister9912504@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "5225 23rd Ave S",
            "city": "Fargo",
            "state": "ND",
            "country_code": "US",
            "postal_code": "581047927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.