Active NPI
Courtney Derus
- Psychologist
- Wausau, WI
National Provider Identifier
1255765335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3605-57
- Practice address
- 114 Grand Ave
Wausau, WI 54403-6214 - Phone
- (715) 845-7175
- Fax
- (715) 845-7142
- NPI assigned
- Aug 26, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3605-57 | WI | Primary |
Addresses
Primary practice location
114 Grand Ave
Wausau, WI 54403-6214
Mailing address
114 Grand Ave
Wausau, WI 54403-6214
Phone (715) 845-7175
Other names 1
- Courtney Elmergreen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2017
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
114 Grand Ave
Wausau, WI 54403-6214
Phone (715) 845-7175
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3605-57 | WI | MD | Psychologist |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Wausau, WI
- NPI 1922173418
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538438400000",
"number": "1255765335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 GRAND AVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544036214",
"telephone_number": "715-845-7175",
"fax_number": "715-845-7142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 GRAND AVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544036214",
"telephone_number": "715-845-7175",
"fax_number": "715-845-7142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERUS",
"first_name": "COURTNEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-26",
"last_updated": "2018-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "3605-57",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "COURTNEY",
"last_name": "ELMERGREEN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; 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.
- 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.