Derek Michaelis

Primary specialty

OptometristTaxonomy code 152W00000X

License

3625 Issued in MN

Practice address

213 W 1St St
Duluth, MN 55802-1909

Phone

(218) 727-1004

NPI assigned

May 7, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

New England College of Optometry, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Relf Eyecare Specialists PAGroup PAC ID 0749193290, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

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.

• Relf Eyecare Specialists PA

  • Ophthalmology Physician
  • Hermantown, MN
  • NPI 1215972617
  Medicare reassignment Care Compare group NPD
• Derin J Van Loon OD PA

  • Optometrist
  • Duluth, MN
  • NPI 1811975931
  Medicare reassignment NPD

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1932764883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 W 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021909",
            "telephone_number": "218-727-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 W 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021909",
            "telephone_number": "218-727-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHAELIS",
        "first_name": "DEREK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-07",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey M Meyer, RD, LD
• Michael Meyer
• Nolan Mathew Meyer, APRN, CNP
• Rachel Moria Meyer, CRNFA
• Rebecca Ann Meyerson
• Karen Genevieve Michalski
• Elisabeth Mary Michaud, DPT
• Nicole M Mickle, RBT
• Brian Midboe
• Luke David Midlo, M.D.

• Optometrist in Duluth, MN
• Providers in Duluth, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.