Derek Kohlhase, MD is a medicare enrolled "Family Medicine" physician in Star, Idaho. His current practice location is
10717 W State St, Star, Idaho. You can reach out to his office (for appointments etc.) via phone at
(208) 302-6300.
Derek Kohlhase is licensed to practice in Idaho (license number M-15600) 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 1407410830.
Physician's Profile
| Full Name | Derek Kohlhase |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 10717 W State St, Star, Idaho |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1407410830
- Provider Enumeration Date: 05/01/2019
- Last Update Date: 07/21/2022
Medicare PECOS Information:
- PECOS PAC ID: 5193052645
- Enrollment ID: I20220803002492
Medical Identifiers
Medical identifiers for Derek Kohlhase such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1407410830 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | MRM-1814 (Idaho) | Secondary |
| 207Q00000X | Family Medicine | M-15600 (Idaho) | 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 Kohlhase allows following entities to bill medicare on his behalf.
| Entity Name | Saint Alphonsus Regional Medical Center Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1649357716
PECOS PAC ID: 3476462359
Enrollment ID: O20040204001036 |
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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 Kohlhase 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 |
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Derek Kohlhase, MD
3340 E Goldstone Dr,
Meridian, ID 83642-1026
Ph: (208) 302-9342 | Derek Kohlhase, MD
10717 W State St,
Star, ID 83669-6046
Ph: (208) 302-6300 |
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