MRS. CAROLE ANNE DERUCKI (FNP-BC) – Family Nurse Practitioner, NPI 1205809225
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,191 NURSE PRACTITIONER in IN
Provider Addresses for MRS. CAROLE ANNE DERUCKI (FNP-BC)
3809 N Main St Ste 100
Mishawaka, IN 465453109
Phone: (574) 520-1700
Fax: (833) 989-0916
Type: Location
2900 LAKEVIEW AVE
SAINT JOSEPH, MI 490852379
Phone: (269) 932-7859
Fax: (269) 932-7859
Type: Location
23448 SHURTE ST
CASSOPOLIS, MI 490319738
Phone: (574) 993-1158
Fax: (269) 408-4346
Type: Mailing
Cedar Street, South Bend, Saint Joseph County, Indiana, 46617, United States
STE 200
SOUTH BEND, IN 466172057
Phone: (574) 472-6700
Fax: (574) 335-0760
Type: Mailing
Trinity Doctor's Office Building, 611, Douglas Road, Mishawaka, Saint Joseph County, Indiana, 46545, United States
SUITE 305
MISHAWAKA, IN 465451464
Phone: (574) 470-6700
Fax: (574) 335-0760
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 95 Open Payments records for all available years, with a total value of $2,340.
Total Amount is formed as General ($2,340) + Research ($0) + Ownership ($0) = $2,340.
Last reported payment date: 2024-11-06 • Largest payer in this snapshot: Teva Pharmaceuticals USA, Inc. ($314).
Total Amount
$2,340
General + Research + Ownership
Payments
95
Total payment records
General Amount
$2,340
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Teva Pharmaceuticals USA, Inc. | $314 |
| ABBVIE INC. | $253 |
| UCB, Inc. | $183 |
| Celgene Corporation | $158 |
| EMD Serono, Inc. | $144 |
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: 2008-10-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20051013000200 | I | Nurse Practitioner | MI | TBD |
| I20081010000222 | I | Nurse Practitioner | IN | 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 |
|---|---|---|---|---|
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 170 | 140 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 74 | 68 | $0 |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 13 | 13 | $0 |
Insurance plans in this area (ZIP 46545)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IN | |
| O P H T H A L M O L O G Y | IN | |
| Internal Medicine | IN |
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