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SAM DERCON MD
NPI 1831777663
Emergency Medicine in Detroit, MI

Active since April 01, 2021PECOS EnrolledAccepts Medicare Assignment
2799 W GRAND BLVD, DETROIT, MI 48202(313) 916-1553 Get Directions Write a Review

NPPES record last updated: November 8, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 8, 2021, Apr 1, 2021 (2 updates tracked since 2021).

About Sam Dercon Md NPPES

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

SAM DERCON MD (NPI 1831777663) is an individual emergency medicine provider in Detroit, Michigan, licensed in Michigan (4351048209) and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1831777663
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameSAM DERCONCredential: MD
Location Address2799 W GRAND BLVDDetroit, MI 48202-2608
Mailing Address2799 W Grand BlvdDetroit, MI 48202-2689 · (313) 461-9533
Phone(313) 916-1553
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateApril 1, 2021
Last NPPES UpdateNovember 8, 20212 updates tracked since enumeration
NPPES CertifiedNovember 8, 2021
✔ NPI 1831777663 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in MI · 4351048209
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.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
2799 W GRAND BLVD, Detroit, MI 48202
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sam Dercon Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5597169490
PECOS Enrollment IDI20250318000647
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48202 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
$90.76 typical visit price
range $58.04 – $177.36
Typical copayment $22.69 (range $14.51 – $44.34)
Most-billed visit code 99203
Established Patient
$102.35 typical visit price
range $18.32 – $143.49
Typical copayment $25.58 (range $4.58 – $35.87)
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 20

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

HENRY FORD HOSPITAL
General Acute Care Hospital
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
DR. BRENT DAVID GRIFFITH M.D.
Radiology (Diagnostic Radiology)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
KANIKA KHANNA M.D
Radiology (Diagnostic Radiology)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
DR. FADL A CHOKR M.D.
Family Medicine
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
AVI COHEN M.D.
Internal Medicine (Pulmonary Disease)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
LINDSEY AURORA
Internal Medicine (Cardiovascular Disease)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
KYLE KRUPA
Nurse Anesthetist, Certified Registered
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600
ALEXANDER GARBARINO
Internal Medicine (Pulmonary Disease)
2799 W GRAND BLVD
DETROIT, MI 48202
Wayne County (313) 916-2600

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 Sam Dercon's NPI number?

The NPI number for Sam Dercon is 1831777663. It was assigned to this individual provider in the NPPES registry on April 1, 2021.

Where is Sam Dercon located?

Sam Dercon practices at 2799 W Grand Blvd, Detroit, MI 48202. The listed phone number is (313) 916-1553.

What is Sam Dercon's specialty?

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

Is Sam Dercon enrolled in Medicare?

Yes. Sam Dercon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Sam Dercon was last updated on November 8, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.