MR. DEREK C LISH (CRNA) – Certified Registered Nurse Anesthetist, NPI 1699914044
Certified Registered Nurse Anesthetist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
265 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in UT
Provider Addresses for MR. DEREK C LISH (CRNA)
5475 S 500 E
Ogden, UT 844056905
Phone: (801) 479-2111
Type: Location
Saint Alphonsus Regional Medical Center, 1055, North Curtis Road, Boise Junction, Boise, Ada County, Idaho, 83706, United States
BOISE, ID 837061309
Phone: (208) 367-6416
Fax: (208) 367-2742
Type: Location
4268, Southeast Hillside Drive, Glen Echo, Portland, Metro, Clackamas County, Oregon, 97267, United States
PORTLAND, OR 972084268
Phone: (503) 372-2740
Fax: (503) 373-2754
Type: Mailing
950 MEDICAL DR
BRIGHAM CITY, UT 843024724
Phone: (435) 734-9471
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2012-07-03
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 |
|---|---|---|---|---|
| I20120703000725 | I | Certified Registered Nurse Anesthetist (Crna) | UT | 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 |
|---|---|---|---|---|
| 00142 | Anesthesia for lens surgery | 23 | 21 | $0 |
| 00812 | Anesthesia for exam of colon using an endoscope | 14 | 14 | $0 |
Insurance plans in this area (ZIP 84405)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| CERTIFIED REGISTERED NURSE ANESTHET | ID | 00142 | Anesthesia for lens surgery | 43 | 39 |
| CERTIFIED REGISTERED NURSE ANESTHET | ID | 00790 | Anesthesia for procedure in upper abdomen including use of an endoscope | 12 | 12 |
| CERTIFIED REGISTERED NURSE ANESTHET | ID | 76942 | Ultrasonic guidance imaging supervision and interpretation for insertion of needle | 18 | 18 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | WA | |
| - | UT | |
| Certified Registered Nurse Anesthetist (Crna) | UT |
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