TARA DERYAVOUSH (D.O) – Internal Medicine Physician, NPI 1851718092
Internal Medicine Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
7,218 INTERNAL MEDICINE in MI
Provider Addresses for TARA DERYAVOUSH (D.O)
15855 19 Mile Rd
Clinton Township, MI 480383504
Phone: (586) 263-2950
Type: Location
17392 W 13 Mile Rd
Beverly Hills, MI 480255438
Phone: (248) 646-8166
Fax: (248) 646-8176
Type: Location
50505 Schoenherr Rd Ste 340
Shelby Township, MI 483153140
Phone: (586) 731-8400
Fax: (586) 731-8406
Type: Location
50505 SCHOENHERR RD STE 340
SHELBY TOWNSHIP, MI 483153140
Phone: (586) 731-8400
Fax: (586) 731-8406
Type: Location
133 S MAIN ST
MOUNT CLEMENS, MI 480432308
Phone: (586) 468-1600
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 62 Open Payments records for all available years, with a total value of $1,113.
Total Amount is formed as General ($1,113) + Research ($0) + Ownership ($0) = $1,113.
Last reported payment date: 2024-12-03 • Largest payer in this snapshot: Exact Sciences Corporation ($270).
Total Amount
$1,113
General + Research + Ownership
Payments
62
Total payment records
General Amount
$1,113
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-03
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Exact Sciences Corporation | $270 |
| Amgen Inc. | $230 |
| Novo Nordisk Inc | $191 |
| Merck Sharp & Dohme LLC | $54 |
| Xeris Pharmaceuticals, Inc. | $41 |
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: 2017-05-22
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 |
|---|---|---|---|---|
| I20170522000933 | I | Internal Medicine | MI | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 244 | 131 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 99 | 99 | $0 |
| G0444 | Annual depression screening, 5 to 15 minutes | 49 | 49 | $0 |
| 93000 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | 26 | 26 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 25 | 25 | $0 |
Insurance plans in this area (ZIP 48038)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | MI | |
| Physician Assistant | MI | |
| Internal Medicine | MI | |
| Family Practice | MI | |
| Nurse Practitioner | MI | |
| Physician Assistant | MI | |
| Nurse Practitioner | MI | |
| Family Practice | MI | |
| Internal Medicine | KY | |
| Family Practice | MI |
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