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DEREK CARL CARLSON MD
NPI 1790775450
Psychiatry & Neurology - Child & Adolescent Psychiatry in Green Bay, WI

Active since October 25, 2005PECOS Enrolled
301 E SAINT JOSEPH ST, GREEN BAY, WI 54301(920) 433-3630 Get Directions Write a Review

NPPES record last updated: November 23, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 23, 2020, Nov 4, 2019, Jan 16, 2018 (3 updates tracked since 2018).

About Derek Carl Carlson Md NPPES

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

DEREK CARL CARLSON MD (NPI 1790775450) is an individual child & adolescent psychiatry provider in Green Bay, Wisconsin, licensed in Wisconsin (61608-20) and active in the NPI registry since October 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790775450
Entity TypeIndividualMale
Primary Taxonomy2084P0804X
Provider Legal NameDEREK CARL CARLSONCredential: MD
Location Address301 E SAINT JOSEPH STGreen Bay, WI 54301-2241
Mailing Address301 E Saint Joseph StGreen Bay, WI 54301-2241 · (920) 433-3630
Phone(920) 433-3630
Sole ProprietorNo
Enumeration DateOctober 25, 2005
Last NPPES UpdateNovember 23, 20203 updates tracked since enumeration
NPPES CertifiedNovember 23, 2020
✔ NPI 1790775450 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · Child & Adolescent PsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084P0804X
Licenses✔ Licensed in WI · 61608-20✔ Licensed in MI · 4301106248
Definition
Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.
301 E SAINT JOSEPH ST, Green Bay, WI 54301
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, Blue Care Network of Michigan and more.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 Carl Carlson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Derek Carlson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Bellin Psychiatric Center Inc.
Same address
Mental Health (Including Community Mental Health Center)
301 E SAINT JOSEPH ST
Green Bay, WI 54301
  • Reassigned Medicare billing, Michigan and Wisconsin enrollments
  • 24 clinicians in this Medicare group
NPI 1598728776 (920) 433-3630
Bellin Memorial Hospital Inc
1.1 mi
Otolaryngology
923 ELIZA ST
Green Bay, WI 54301
  • Reassigned Medicare billing, Wisconsin enrollment
  • 875 clinicians in this Medicare group
NPI 1932565272 (920) 965-4800

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

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. EMILY R RADEMACHER D.O., M.B.A.
Psychiatry & Neurology (Psychiatry)
301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
Brown County (920) 433-3630
PATSY L WHITE MSW
Counselor
301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
Brown County (920) 433-3630
JONI CONSTANCE DELWICHE LCSW
Social Worker (Clinical)
301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
Brown County (920) 433-6073
GABRIELLE MARIE RODRIGUEZ PSY.D
Psychologist
301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
Brown County (920) 433-6073
AMANDA ROSE GILLESPIE APNP, PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
Brown County (920) 431-5533
BRIAN J CAGLE PSYD
Psychologist
301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
Brown County (920) 433-6073
ELIZABETH DIONNE DANTOIN LPC
Counselor (Professional)
301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
Brown County (920) 433-6073
CARRIE B ISON LCSW,SAC
Social Worker (Clinical)
301 E SAINT JOSEPH ST
GREEN BAY, WI 54301
Brown County (920) 433-3630

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 Carlson's NPI number?

The NPI number for Derek Carlson is 1790775450. It was assigned to this individual provider in the NPPES registry on October 25, 2005.

Where is Derek Carlson located?

Derek Carlson practices at 301 E Saint Joseph St, Green Bay, WI 54301. The listed phone number is (920) 433-3630.

What is Derek Carlson's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry, with taxonomy code 2084P0804X.

Is Derek Carlson enrolled in Medicare?

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

Which organizations bill Medicare for Derek Carlson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Derek Carlson reassigns Medicare benefits to 2 organizations: Bellin Psychiatric Center Inc. (Green Bay, WI) and Bellin Memorial Hospital Inc (Green Bay, WI). 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 Carlson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Derek Carlson accept?

Health plans from Anthem Blue Cross and Blue Shield, Aspirus Health Plan, Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company and CareSource (Common Ground Healthcare) and 2 other insurers list Derek Carlson 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 Carlson was last updated on November 23, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.