ROBERT JOHN DERBY (NP) – Nurse Practitioner, NPI 1104593060
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,033 NURSE PRACTITIONER in WI
Provider Addresses for ROBERT JOHN DERBY (NP)
2500 OVERLOOK TER
MADISON, WI 537052286
Phone: (608) 293-4015
Type: Mailing
1141 BLACK BRIDGE RD
JANESVILLE, WI 535451092
Phone: (608) 758-9300
Type: Location
BELOIT HEALTH SYSTEMS INC
1969 W HART ROAD
BELOIT, WI 535112230
Phone: (608) 364-2293
Fax: (608) 364-5525
Type: Mailing
BELOIT CLINIC
1905 E HUEBBE PARKWAY
BELOIT, WI 535111842
Phone: (608) 364-1640
Fax: (608) 363-7393
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 9 Open Payments records for all available years, with a total value of $225.
Total Amount is formed as General ($225) + Research ($0) + Ownership ($0) = $225.
Last reported payment date: 2024-10-24 • Largest payer in this snapshot: TREACE MEDICAL CONCEPTS, INC. ($128).
Total Amount
$225
General + Research + Ownership
Payments
9
Total payment records
General Amount
$225
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
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: 2023-12-08
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 |
|---|---|---|---|---|
| I20231207002676 | I | Nurse Practitioner | IL | TBD |
| I20231208000783 | I | Nurse Practitioner | WI | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 53705)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WI | |
| Family Practice | WI | |
| Nurse Practitioner | WI | |
| Nurse Practitioner | WI | |
| Family Practice | WI | |
| Family Practice | WI | |
| Family Practice | WI | |
| Infectious Disease | WI | |
| Internal Medicine | NY | |
| Family Practice | WI |
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