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
- 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
- Code Navigator
Location Map
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) |
---|---|---|---|---|
1 | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | 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. | |||||||||
1 | 7 | 9 | 0 | 7 | 7 | 5 | 4 | 5 | 0 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 7 | 18 | 0 | 14 | 7 | 10 | 4 | 10 | |
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 | Counselor | 301 E SAINT JOSEPH ST GREEN BAY, WI 54301 (920) 433-3673 |
1467437723 | MARY L HILL LCSW Individual | Social Worker | 301 E SAINT JOSEPH ST GREEN BAY, WI 54301 (920) 433-6073 |
1881679124 | BLISS A BAUDHUIN LPC Individual | Counselor | 301 E SAINT JOSEPH ST GREEN BAY, WI 54301 (920) 433-6073 |
1306821673 | LESLIE A KOCHA APSW Individual | Social Worker | 301 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 Worker | 301 E SAINT JOSEPH ST GREEN BAY, WI 54301 (920) 433-6073 |
1982689188 | DONNA L RASMUSSEN LCSW Individual | Social Worker | 301 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 Worker | 301 E SAINT JOSEPH ST GREEN BAY, WI 54301 (920) 433-6073 |
1659358620 | DR. CARLOS S CASTILLO MD Individual | Psychiatry & Neurology (Psychiatry) | 301 E SAINT JOSEPH ST GREEN BAY, WI 54301 (920) 433-3630 |
1801824305 | BELLIN PSYCHIATRIC CENTER INC Organization | Psychiatric Hospital | 301 E SAINT JOSEPH ST GREEN BAY, WI 54301 (920) 433-3630 |
1205044112 | MARY L GIBSON MS Individual | Counselor | 301 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 |
1457677338 | BELLIN PSYCHIATRIC CENTER Organization | Clinic/Center | 301 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 |
1679879167 | MS. 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 | Counselor | 301 E SAINT JOSEPH ST GREEN BAY, WI 54301 (920) 433-3630 |
1780648022 | RICHARD F. RIDER PSY.D. Individual | Psychologist | 301 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.