Mikayla Marie Van Dervoort, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

180 Main St
Saugus, MA 01906-3213

Phone

(339) 674-0978

Fax

(339) 574-0914

NPI assigned

Jun 24, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Convenientmd - FFS UC LLCGroup PAC ID 5193186492, 397 clinicians

Pratt Medical Group IncGroup PAC ID 3375515661, 282 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tufts Medical Center Hospital, Boston, MA, CCN 220116

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Pratt Medical Group, Inc

  dba Pratt Medical Group, Inc-General Medical Associates

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1275570319
  Medicare reassignment Care Compare group NPD
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Worcester, MA
  • NPI 1790528628
  Medicare reassignment Care Compare group
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Sturbridge, MA
  • NPI 1386526192
  NPD
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Dedham, MA
  • NPI 1760174809
  NPD
• Pratt Medical Group, Inc

  dba Pratt Medical Group, Inc - Gastroenterology

  • Gastroenterology Physician
  • Boston, MA
  • NPI 1013237809
  NPD
• Pratt Medical Group, Inc

  dba Pratt Medical Group, Inc - Pulmonary Disease

  • Pulmonary Disease Physician
  • Boston, MA
  • NPI 1508187642
  NPD
• Pratt Medical Group, Inc

  dba Pratt Orthopaedics Associates, Inc

  • Orthopaedic Surgery Physician
  • Boston, MA
  • NPI 1184661225
  NPD (past)

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

• Tufts Medical Center, Inc.

  dba Tufts Medical Center

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1730132515
  Care Compare affiliation

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

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1649014614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 US HIGHWAY 1 BYP UNIT 102",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017105",
            "telephone_number": "603-410-6700",
            "fax_number": "603-309-8308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 MAIN ST",
            "city": "SAUGUS",
            "state": "MA",
            "postal_code": "019063213",
            "telephone_number": "339-674-0978",
            "fax_number": "339-574-0914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DERVOORT",
        "first_name": "MIKAYLA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edith Tusubira
• Marie Ulysse
• Universal Hands Care Services LLC
• Christine Valdes, MD
• Anthony O. Valenza, RPH., CDM, MTM
• Adriana Cogliandro Vaughan
• Isabel Oliveira Ventura
• Rosemarie Grace Verderico, MSW
• Cara Vincelette
• Keri Virgin

• Physician Assistant in Saugus, MA
• Providers in Saugus, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; 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.

Verify at the official NPI Registry.