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DR. CHERI DIANE DERSAM M.D.
NPI 1811905177
Emergency Medicine in Phoenix, AZ

Active since August 03, 2006Opted out of Medicare · through Oct 26, 2026
4730 E INDIAN SCHOOL RD, SUITE 211, PHOENIX, AZ 85018(602) 354-3491 Get Directions Write a Review

NPPES record last updated: October 20, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Cheri Diane Dersam M.d. NPPES

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

DR. CHERI DIANE DERSAM M.D. (NPI 1811905177) is an individual emergency medicine provider in Phoenix, Arizona, licensed in Arizona (31114) and active in the NPI registry since August 2006. She has opted out of Medicare through October 26, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1811905177
Entity TypeIndividualFemale
Primary Taxonomy207P00000X
Provider Legal NameDR. CHERI DIANE DERSAMCredential: M.D.
Location Address4730 E INDIAN SCHOOL RD, SUITE 211Phoenix, AZ 85018-5441
Mailing Address6131 E Calle RosaScottsdale, AZ 85251-4222 · (480) 874-5835
Phone(602) 354-3491
Sole ProprietorNo
Enumeration DateAugust 3, 2006
Last NPPES UpdateOctober 20, 2007
✔ NPI 1811905177 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in AZ · 31114
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
4730 E INDIAN SCHOOL RD, Phoenix, AZ 85018
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Other Identifiers 3

Medicaid77634604AZ
Medicare UPINH28312IN
Medicare PINZ114158AZ

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, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Cheri Diane Dersam M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 26, 2016 through October 26, 2026.

Opt-Out Effective DateOctober 26, 2016
Opt-Out In Effect ThroughOctober 26, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85018 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

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

DR. JOHN N. HARMAN IV D.D.S.
Dentist (General Practice)
4730 E INDIAN SCHOOL RD, SUITE 210
PHOENIX, AZ 85018
Maricopa County (602) 840-5300
DEION TRAN
Physician Assistant
4730 E INDIAN SCHOOL RD, SUITE #211
PHOENIX, AZ 85018
Maricopa County (602) 354-3491
MARY ELIZABETH YOUNG D.O.
Emergency Medicine
4730 E INDIAN SCHOOL RD, SUITE 211
PHOENIX, AZ 85018
Maricopa County (602) 354-3491
JOSEPH PANDOLFI III PA-C
Physician Assistant
4730 E INDIAN SCHOOL RD
PHOENIX, AZ 85018
Maricopa County (602) 354-3491
EMURGENT CARE PLLC
Clinic/Center (Urgent Care)
4730 E INDIAN SCHOOL RD, SUITE 211
PHOENIX, AZ 85018
Maricopa County (602) 354-3491
MICHAEL WILLIAM HICKMAN DO
Emergency Medicine
4730 E INDIAN SCHOOL RD, #211
PHOENIX, AZ 85018
Maricopa County (602) 354-3491

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 Cheri Dersam's NPI number?

The NPI number for Cheri Dersam is 1811905177. It was assigned to this individual provider in the NPPES registry on August 3, 2006.

Where is Cheri Dersam located?

Cheri Dersam practices at 4730 E Indian School Rd Suite 211, Phoenix, AZ 85018. The listed phone number is (602) 354-3491.

What is Cheri Dersam's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Cheri Dersam enrolled in Medicare?

No. Cheri Dersam has opted out of Medicare through October 26, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Cheri Dersam accept?

Health plans from Blue Cross Blue Shield of Arizona list Cheri Dersam 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 Cheri Dersam was last updated on October 20, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.