SAMIR DERISAVIFARD (MD) – Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician, NPI 1477997690
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
861 UROLOGY in TX
Provider Addresses for SAMIR DERISAVIFARD (MD)
811 W INTERSTATE 20 STE 114
ARLINGTON, TX 760175871
Phone: (817) 784-8268
Fax: (817) 804-8178
Type: Mailing
9225 QUEENS BLVD FL 2
REGO PARK, NY 11374
Phone: (817) 925-6200
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 $885.
Total Amount is formed as General ($885) + Research ($0) + Ownership ($0) = $885.
Last reported payment date: 2024-10-24 • Largest payer in this snapshot: FEMSelect Inc. ($427).
Total Amount
$885
General + Research + Ownership
Payments
16
Total payment records
General Amount
$885
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| FEMSelect Inc. | $427 |
| Medtronic, Inc. | $347 |
| Axonics, Inc. | $96 |
| Boston Scientific Corporation | $16 |
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: 2022-09-15
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 |
|---|---|---|---|---|
| I20220915000925 | I | Urology | NY | 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 |
|---|---|---|---|---|
| 51798 | Ultrasound measurement of bladder capacity after voiding | 95 | 86 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 86 | 59 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 49 | 41 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 41 | 41 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 30 | 25 | $0 |
Insurance plans in this area (ZIP 76017)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine, Cardiovascular Disease (Cardiology) | NY | |
| O B S T E T R I C S/ G Y N E C O L O G Y | NY | |
| P O D I A T R Y | NY | |
| Gastroenterology, Internal Medicine | NY | |
| U R O L O G Y | NY | |
| Cardiovascular Disease (Cardiology), Internal Medicine | NY | |
| G A S T R O E N T E R O L O G Y | NY | |
| U R O L O G Y | NY | |
| U R O L O G Y | NY | |
| U R O L O G Y | IN |
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