Tara Deryavoush, D.O

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5101020870 Issued in MI

Practice address

133 S Main St
Mount Clemens, MI 48043-2308

Phone

(586) 468-1600

NPI assigned

Mar 26, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Internal Medicine

Education

Michigan State University College of Osteopathic Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Physician PartnersGroup PAC ID 8921482605, 79 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047
• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
• Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
• McLaren Macomb Hospital, Mount Clemens, MI, CCN 230227

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tderyavoush584635@direct.beaumont.edu
• Direct secure messaging: tderyavousch259967@direct.hfhs.org

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.

• Henry Ford Physician Partners

  • Internal Medicine Physician
  • Mount Clemens, MI
  • NPI 1427703602
  Medicare reassignment Care Compare group NPD
• Alliance Health Professionals, PLLC

  • Internal Medicine Physician
  • Mount Clemens, MI
  • NPI 1841615648
  Medicare reassignment NPD
• Henry Ford Macomb Ancillary Services

  • Clinical Medical Laboratory
  • Mount Clemens, MI
  • NPI 1669864708
  NPD
• Henry Ford Physician Partners

  dba Henry Ford Physician Partners - PCS

  • Cardiovascular Disease Physician
  • Dearborn, MI
  • NPI 1366219651
  NPD
• Internal Medicine Associates of Mt. Clemens, PC

  • Internal Medicine Physician
  • Mount Clemens, MI
  • NPI 1306842190
  NPD

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

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation
• Henry Ford Macomb Hospital Corporation

  dba Henry Ford Health Macomb Hospital

  • General Acute Care Hospital
  • Clinton TWP, MI
  • NPI 1023114634
  Care Compare affiliation
• Henry Ford Macomb Hospital Corporation

  • General Acute Care Hospital
  • Warren, MI
  • NPI 1902842735
  Care Compare affiliation
• McLaren Macomb

  • Psychiatric Hospital Unit
  • Shelby Township, MI
  • NPI 1184206385
  Care Compare affiliation
• McLaren Macomb

  • General Acute Care Hospital
  • Mount Clemens, MI
  • NPI 1316938327
  Care Compare affiliation
• Henry Ford Health St. John Hospital

  dba St John Hospital and Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  Care Compare affiliation

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1851718092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50505 SCHOENHERR RD STE 340",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153140",
            "telephone_number": "586-731-8400",
            "fax_number": "586-731-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 S MAIN ST",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432308",
            "telephone_number": "586-468-1600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15855 19 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Clinton Township",
            "state": "MI",
            "postal_code": "480383504",
            "country_code": "US",
            "telephone_number": "586-263-2950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17392 W 13 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Beverly Hills",
            "state": "MI",
            "postal_code": "480255438",
            "country_code": "US",
            "telephone_number": "248-646-8166",
            "fax_number": "248-646-8176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "50505 Schoenherr Rd Ste 340",
            "address_purpose": "LOCATION",
            "city": "Shelby Township",
            "state": "MI",
            "postal_code": "483153140",
            "country_code": "US",
            "telephone_number": "586-731-8400",
            "fax_number": "586-731-8406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERYAVOUSH",
        "first_name": "TARA",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-26",
        "last_updated": "2022-07-21",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "5101020870",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101020870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "TDERYAVOUSH584635@DIRECT.BEAUMONT.EDU",
            "affiliation": "N",
            "address_1": "17392 W 13 Mile Rd",
            "city": "Beverly Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480255438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Glenn A Delong, DO
• Allison Dembeck
• Pamela Denise, RN
• Michael Dennie, NP
• Susan R Depowski
• Christopher Michael Desjardins
• Christine L Dex, CRNA
• Michael Blair Deyoung, D.O.
• Yunis Ali Dhalai
• Hemal Raghuvir Dholakia

• Internal Medicine Physician in Mount Clemens, MI
• Providers in Mount Clemens, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.