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DEREK S POULSON CRNA
NPI 1033412440
Nurse Anesthetist, Certified Registered in Goshen, IN

Active since December 08, 2010
57809 HILLSIDE DR, GOSHEN, IN 46528(801) 623-7813 Get Directions Write a Review

NPPES record last updated: November 18, 2013. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Derek S Poulson Crna NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEREK S POULSON CRNA (NPI 1033412440) is an individual nurse anesthetist, certified registered in Goshen, Indiana, licensed in Maine (AA103025) and active in the NPI registry since December 2010.

NPPES Registry Identity

NPI1033412440
Entity TypeIndividualMale
Primary Taxonomy367500000X
Provider Legal NameDEREK S POULSONCredential: CRNA
Location Address57809 HILLSIDE DRGoshen, IN 46528-4402
Mailing Address57809 Hillside DrGoshen, IN 46528-4402 · (801) 623-7813
Phone(801) 623-7813
Sole ProprietorNo
Enumeration DateDecember 8, 2010
Last NPPES UpdateNovember 18, 2013
✔ NPI 1033412440 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
License✔ Licensed in ME · AA103025
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
57809 HILLSIDE DR, Goshen, IN 46528
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Derek S Poulson Crna is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignments

3

Medicare enrollment records show Derek Poulson reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

North Gate Anesthesia PC
1,540 mi
Nurse Anesthetist, Certified Registered
1780 E FLORENCE BLVD STE 104
Casa Grande, AZ 85122
  • Reassigned Medicare billing, Arizona enrollment
  • 3 clinicians in this Medicare group
NPI 1073026464 (480) 323-5131
Greater Anesthesia Solutions
1,549 mi
Anesthesiology
10720 W INDIAN SCHOOL RD STE 19-1039
Phoenix, AZ 85037
  • Reassigned Medicare billing, Arizona enrollment
  • 423 clinicians in this Medicare group
NPI 1124430244 (480) 977-9559
Valley Regional Anesthesia Associates Inc
1,837 mi
Anesthesiology
7341 N 1ST ST STE 106
Fresno, CA 93720
  • Reassigned Medicare billing, California enrollment
  • 293 clinicians in this Medicare group
NPI 1578272415 (559) 289-4574

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derek Poulson's NPI number?

The NPI number for Derek Poulson is 1033412440. It was assigned to this individual provider in the NPPES registry on December 8, 2010.

Where is Derek Poulson located?

Derek Poulson practices at 57809 Hillside Dr, Goshen, IN 46528. The listed phone number is (801) 623-7813.

What is Derek Poulson's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Derek Poulson enrolled in Medicare?

Yes. Derek Poulson is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Derek Poulson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Derek Poulson reassigns Medicare benefits to 3 organizations: North Gate Anesthesia PC (Casa Grande, AZ), Greater Anesthesia Solutions (Phoenix, AZ) and Valley Regional Anesthesia Associates Inc (Fresno, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Derek Poulson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Derek Poulson accept?

Health plans from Blue Cross Blue Shield of Arizona list Derek Poulson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Derek Poulson was last updated on November 18, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.