Michael L Deters, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

19538 Issued in IA

Practice address

1443 Prospect Blvd
Waterloo, IA 50701-4953

Phone

(319) 234-6553

Fax

(319) 272-2038

NPI assigned

Dec 29, 2005

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 2

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Cedar Valley Hospice, Inc.

  • Community Based Hospice Care Agency
  • Waterloo, IA
  • NPI 1730304619
  NPD (past)

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222387200000",
    "number": "1346227477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2880",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507042880",
            "telephone_number": "319-272-2152",
            "fax_number": "319-272-2038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1443 PROSPECT BLVD",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507014953",
            "telephone_number": "319-234-6553",
            "fax_number": "319-272-2038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETERS",
        "first_name": "MICHAEL",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2008-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "19538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0128801",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110115799",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Stuart Dennis, CRNA
• Department of Veterans Affairs Outpatient Clinic
• Dermatology Associates PC
• Elizabeth Ann Derr, LISW
• Kelli Deserano, ARNP
• Mary Ellen Deutmeyer, A.R.N.P
• Devotion Transport LLC
• Laura Dewey, MT-BC
• Joud Ghassoub Dib, M.D.
• Jason Dibben, LMSW

• All providers in Waterloo, IA
• Internal Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.