Derek S Versalle, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

5151016178 Issued in MI

Practice address

950 Trade Centre Way
Portage, MI 49002-0487

Phone

(269) 370-1824

NPI assigned

May 12, 2023

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

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Emergency Medicine

Education

Michigan State University College of Osteopathic Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southwestern Michigan Emergency Services, PCGroup PAC ID 1456265891, 69 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southwestern Michigan Emergency Services, PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Kalamazoo, MI
  • NPI 1013021310
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785283200000",
    "number": "1669162616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 TRADE CENTRE WAY STE 230",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490020492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 TRADE CENTRE WAY",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490020487",
            "telephone_number": "269-370-1824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERSALLE",
        "first_name": "DEREK",
        "middle_name": "S",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-12",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5151016178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Vaughn
• Clarissa Vazquez
• Debbie Veeder
• Miriam Yvonne Veldt, MD
• Mauli A Verma, M.D.
• Brianna L Vestal
• Vonika Vicioso
• Bethany Louise Vinatieri, LMSW
• Visiting Home MD (Physical Medicine and Rehabilitation Specialists of Michigan)
• Visiting Nurses Home Care (Borgess Home Care)

• Emergency Medicine Physician in Portage, MI
• Providers in Portage, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; 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.