DEREK CARL CARLSON MD
NPI 1790775450
Psychiatry & Neurology - Child & Adolescent Psychiatry in Green Bay, WI

NPI Status: Active since October 25, 2005

Contact Information

301 E SAINT JOSEPH ST
GREEN BAY, WI
ZIP 54301
Phone: (920) 433-3630

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  • Individual
  • Male
  • Years of Experience 32
  • Psychiatry & Neurology
  • Child & Adolescent Psychiatry
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About DEREK CARLSON

This page provides the complete NPI Profile along with additional information for Derek Carlson, a provider established in Green Bay, Wisconsin with a medical specialization in Psychiatry & Neurology, focusing in child & adolescent psychiatry and more than 32 years of experience. The healthcare provider is registered in the NPI registry with number 1790775450 assigned on October 2005. The practitioner's primary taxonomy code is 2084P0804X with license number 61608-20 (WI). The provider is registered as an individual and his NPI record was last updated 5 years ago.

NPI
1790775450
Provider Name
DEREK CARL CARLSON MD
Gender
Male
Entity Type
Individual
Location Address
301 E SAINT JOSEPH ST GREEN BAY, WI 54301
Location Phone
(920) 433-3630
Mailing Address
301 E SAINT JOSEPH ST GREEN BAY, WI 54301
Mailing Phone
(920) 433-3630
Medical School Name
OTHER
Graduation Year
1994
Is Sole Proprietor?
No
Enumeration Date
10-25-2005
Last Update Date
11-23-2020
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Psychiatry & Neurology Child & Adolescent Psychiatry

Taxonomy Code
2084P0804X
Type
Allopathic & Osteopathic Physicians
License No.
61608-20
License State
WI
Taxonomy Description
Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
12084P0804XAllopathic & Osteopathic Physicians

Psychiatry & Neurology
Child & Adolescent Psychiatry

4301106248 (MI)

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
  • Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
  • Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Anthem Bronze Priority/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - HMO
  • Anthem Bronze Priority/Lean HSA (+ Incentives) - HMO
  • Anthem Bronze Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
  • Anthem Gold Priority/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • Anthem Gold Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
  • HMO Bronze $0 Medical Deductible - HMO
  • HMO Bronze 7500 - HMO
  • HMO Catstrophic 9200 with 3 Free PCP Visits - HMO
  • HMO Gold 1500 - HMO
  • HMO Gold 2400 - HMO
  • HMO HDHP Bronze 7200 - HMO
  • HMO HDHP Silver 5400 - HMO
  • HMO Silver 5000 - HMO
  • HMO Silver 6600 - HMO
  • POS Bronze 7500 - POS
  • Chorus Bronze Complete - EPO
  • Chorus Bronze HDHP - EPO
  • Chorus Catastrophic - EPO
  • Chorus Core Bronze - EPO
  • Chorus Core Gold - EPO
  • Chorus Core Silver - EPO
  • Chorus Elite Gold - EPO
  • Chorus Gold - EPO
  • Chorus Silver - EPO
  • Chorus Silver Select - EPO
  • CGHC Bronze $0 Ded / $2250 Rx Ded - Envision Network - EPO
  • CGHC Bronze $0 Ded / $2250 Rx Ded - Envision Network (Vision Exam) - EPO
  • CGHC Bronze $9200 ($40 PCP Copay) - Envision Network - EPO
  • CGHC Bronze $9200 ($40 PCP Copay) - Envision Network (Vision Exam) - EPO
  • CGHC Bronze Standard $7500 - Envision Network - EPO
  • CGHC Bronze Standard $7500 - Envision Network (Vision Exam) - EPO
  • CGHC Catastrophic $9200 - Envision Network - EPO
  • CGHC Gold $0 Ded - Envision Network - EPO
  • CGHC Gold $0 Ded - Envision Network (Vision Exam) - EPO
  • CGHC Gold $3000 - Envision Network - EPO
  • Atlas $1,000 Gold - PPO
  • Atlas $1,500 Standard Gold - PPO
  • Atlas $2,650 Plus Silver - PPO
  • Atlas $3,500 HSA Silver - PPO
  • Atlas $5,000 Standard Silver - PPO
  • Atlas $6,500 Plus Bronze - PPO
  • Atlas $7,500 Standard Bronze - PPO
  • Atlas $8,200 HSA Bronze - PPO
  • Atlas $9,200 Catastrophic - PPO
  • Robin Oak $1,000 Gold - PPO
  • Engage by Medica Bronze HSA - EPO
  • Engage by Medica Bronze Share - EPO
  • Engage by Medica Expanded Bronze Standard - EPO
  • Engage by Medica Gold $0 Copay PCP Visits - EPO
  • Engage by Medica Gold Share - EPO
  • Engage by Medica Gold Standard - EPO
  • Engage by Medica Silver $0 Copay PCP Visits - EPO
  • Engage by Medica Silver Share - EPO
  • Engage by Medica Silver Standard - EPO
  • Essentia Choice Care with Medica Bronze HSA - EPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Derek Carlson is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Derek Carlson is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 6507914694

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20140218001665, I20141027000351

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1790775450
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2718014710410
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 1 + 8 + 0 + 1 + 4 + 7 + 1 + 0 + 4 + 1 + 0 + 24 = 60
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
0

The NPI number 1790775450 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1528043858 DENISE M BALZOLA MSW
Individual
Counselor (Mental Health)301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1568447811 JOLAYNE M BOEHMKE LPC
Individual
Counselor301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-3673
1467437723 MARY L HILL LCSW
Individual
Social Worker301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1881679124 BLISS A BAUDHUIN LPC
Individual
Counselor301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1306821673 LESLIE A KOCHA APSW
Individual
Social Worker301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1235114513 KIM L LASECKI PHD
Individual
Psychologist (Clinical Child & Adolescent)301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1831174119 MARGARET ROSE LEGLER LCSW
Individual
Social Worker (Clinical)301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1962487116 ERIC L LAVARDA LPC
Individual
Social Worker301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1982689188 DONNA L RASMUSSEN LCSW
Individual
Social Worker301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1053396796 JONI CONSTANCE DELWICHE LCSW
Individual
Social Worker (Clinical)301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1588649222 LYNETTE MARIE HARRIS LCSW
Individual
Social Worker301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-6073
1659358620DR. CARLOS S CASTILLO MD
Individual
Psychiatry & Neurology (Psychiatry)301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-3630
1801824305BELLIN PSYCHIATRIC CENTER INC
Organization
Psychiatric Hospital301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-3630
1205044112 MARY L GIBSON MS
Individual
Counselor301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 430-3630
1114135167 MARY M MCKAY CADC LLL
Individual
Counselor (Addiction (Substance Use Disorder))301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-3630
1457677338BELLIN PSYCHIATRIC CENTER
Organization
Clinic/Center301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-3630
1174839336 PATRICIA L VANDERMAUSE LPC ,CSAC
Individual
Counselor (Professional)301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-3630
1679879167MS. ABBIE HONZIK RNC MSE
Individual
Counselor (Mental Health)301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 431-5533
1033497755 PATSY L WHITE MSW
Individual
Counselor301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-3630
1780648022 RICHARD F. RIDER PSY.D.
Individual
Psychologist301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
(920) 433-7992

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1790775450, enumerated in the NPI registry as an "individual" on October 25, 2005

The provider is located at 301 E Saint Joseph St Green Bay, Wi 54301 and the phone number is (920) 433-3630

The provider's speciality is Psychiatry & Neurology with taxonomy code 2084P0804X with a focus in Child & Adolescent Psychiatry

The provider has more than 32 years of experience.

The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Aspirus Health. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

This NPI record was last updated on October 25, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.