Derek S Poulson, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Goshen, Indiana. His current practice location is
57809 Hillside Dr, Goshen, Indiana. You can reach out to his office (for appointments etc.) via phone at
(801) 623-7813.
Derek S Poulson is licensed to practice in Maine (license number AA103025) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1033412440.
Provider's Profile
Full Name | Derek S Poulson |
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Gender | Male |
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Speciality | Nurse Anesthetist, Certified Registered |
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Location | 57809 Hillside Dr, Goshen, Indiana |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1033412440
- Provider Enumeration Date: 12/08/2010
- Last Update Date: 11/18/2013
Medicare PECOS Information:
- PECOS PAC ID: 0345421566
- Enrollment ID: I20141031000894
Medical Identifiers
Medical identifiers for Derek S Poulson such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1033412440 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
367500000X | Nurse Anesthetist, Certified Registered | AA103025 (Maine) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Derek S Poulson allows following entities to bill medicare on his behalf.
Entity Name | Great Lakes Anesthesia Indiana And Michigan Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1891069605 PECOS PAC ID: 4981850005 Enrollment ID: O20120806000573 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Derek S Poulson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Derek S Poulson, CRNA 57809 Hillside Dr, Goshen, IN 46528-4402 Ph: (801) 623-7813 | Derek S Poulson, CRNA 57809 Hillside Dr, Goshen, IN 46528-4402 Ph: (801) 623-7813 |
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