DR. THEODORE SCOTT DERSE (MD) – Family Medicine Physician, NPI 1336254515
Family Medicine Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
5,037 FAMILY PRACTICE in IL
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Provider Addresses for DR. THEODORE SCOTT DERSE (MD)
Lewis Avenue, Zion, Lake County, Illinois, 60099, United States
ZION, IL 600993099
Phone: (847) 746-3752
Fax: (847) 746-9144
Type: Location
3115 Lewis Ave
Zion, IL 600993099
Phone: (847) 746-3752
Fax: (847) 746-9144
Type: Location
PO BOX 602195
CHARLOTTE, NC 282602195
Phone: (877) 498-4490
Type: Mailing
1260 N ARENDELL AVE
ZEBULON, NC 275978730
Phone: (919) 235-1965
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 16 Open Payments records for all available years, with a total value of $314.
Total Amount is formed as General ($314) + Research ($0) + Ownership ($0) = $314.
Last reported payment date: 2024-12-11 • Largest payer in this snapshot: Novo Nordisk Inc ($177).
Total Amount
$314
General + Research + Ownership
Payments
16
Total payment records
General Amount
$314
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $177 |
| Lilly USA, LLC | $81 |
| ABBVIE INC. | $34 |
| Kyowa Kirin, Inc. | $21 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-07-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20220711000512 | I | Family Practice | NC | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 178 | 161 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 94 | 94 | $0 |
| 81003 | Automated urinalysis test | 46 | 42 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 29 | 28 | $0 |
| 87635 | Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen | 19 | 19 | $0 |
Insurance plans in this area (ZIP 60099)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | NC | |
| Family Practice | NC | |
| Family Practice | NC | |
| Nurse Practitioner | NC | |
| Physician Assistant | NC | |
| Family Practice | NC | |
| - | NC | |
| Family Practice | NC | |
| Nurse Practitioner | NC | |
| Family Practice, Geriatric Medicine, Hospice/Palliative Care | NC |
Reviews
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