Derek Brian Lauritzen, M.D.

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

G77319 Issued in CA

Practice address

941 California Blvd
San Luis Obispo, CA 93401

Phone

(805) 434-2350

Fax

(805) 434-9888

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CA

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

Ophthalmology

Education

Tufts University School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/ZovcCzFH9WoaIYAtfnADtCEJJqhJ7vbO/
• FHIR API: https://app.meldrx.com/api/fhir/imedicware_chamg

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.

• Central Coast Eye Surgery, Inc., a Professional Medical Corporation

  • Retina Specialist (Ophthalmology) Physician
  • San Luis Obispo, CA
  • NPI 1508380031
  Medicare reassignment NPD Authorized official
• Cha Medical and Surgical Group, PC

  • Ophthalmology Physician
  • Los Angeles, CA
  • NPI 1194209254
  NPD
• Doctors Medical Center of Modesto, Inc.

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1184654923
  NPD (past)
• Rocky Mountain Retina Consultants

  • Retina Specialist (Ophthalmology) Physician
  • Salt Lake City, UT
  • NPI 1710980354
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1841348166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 CALIFORNIA BLVD",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012905",
            "telephone_number": "805-544-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "941 CALIFORNIA BLVD",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "93401",
            "telephone_number": "805-434-2350",
            "fax_number": "805-434-9888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 Las Tablas Rd Ste 6",
            "address_purpose": "LOCATION",
            "city": "Templeton",
            "state": "CA",
            "postal_code": "934659792",
            "country_code": "US",
            "telephone_number": "805-434-2350",
            "fax_number": "805-434-9888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAURITZEN",
        "first_name": "DEREK",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G77319",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "CA",
            "license": "G77319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "7808216",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G773190",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "G77319",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "00G773190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Timothy Larson
• Alan Latta, D.D.S.
• Tina Lau-Vaca, PPS
• Lauren Edwards Pelvic Health LLC
• Lauren Prewitt, D.O., Inc
• Derek Smith Lauritzen
• Lindsey M Law, IBCLC
• James W Lawler, MD
• David L Lawrence, M.D.
• Ryan Lawrence, PT

• Retina Specialist (Ophthalmology) Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Retina Specialist (Ophthalmology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.