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TARA DERYAVOUSH D.O
NPI 1851718092
Internal Medicine in Mount Clemens, MI

Active since March 26, 2014PECOS EnrolledAccepts Medicare Assignment
133 S MAIN ST, MOUNT CLEMENS, MI 48043(586) 468-1600 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 21, 2022, Jul 15, 2022, Dec 20, 2018 and 3 more (6 updates tracked since 2017).

About Tara Deryavoush D.o NPPES

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

TARA DERYAVOUSH D.O (NPI 1851718092) is an individual internal medicine provider in Mount Clemens, Michigan, licensed in Michigan (5101020870) and active in the NPI registry since March 2014. She is enrolled in Medicare PECOS, is affiliated with Henry Ford Macomb Hospital, and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1851718092
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameTARA DERYAVOUSHCredential: D.O
Location Address133 S MAIN STMount Clemens, MI 48043-2308
Mailing Address50505 Schoenherr Rd Ste 340Shelby Township, MI 48315-3140 · (586) 731-8400 · Fax (586) 731-8406
Phone(586) 468-1600
Sole ProprietorNo
Medical School CMSMichigan State University College Of Osteopathic MedicineGraduated 2014
Enumeration DateMarch 26, 2014
Last NPPES UpdateJuly 21, 20226 updates tracked since enumeration
NPPES CertifiedMay 2, 2022
✔ NPI 1851718092 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MI · 5101020870
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedHospitalistTaxonomy 208M00000X · License 5101020870 (MI)
133 S MAIN ST, Mount Clemens, MI 48043
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Secondary Practice Locations 3

Location 115855 19 Mile RdClinton Township, MI 48038-3504 · Phone (586) 263-2950
Location 217392 W 13 Mile RdBeverly Hills, MI 48025-5438 · Phone (248) 646-8166 · Fax (248) 646-8176
Location 350505 Schoenherr Rd Ste 340Shelby Township, MI 48315-3140 · Phone (586) 731-8400 · Fax (586) 731-8406

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

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

Tara Deryavoush D.o 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 ID3577783232
PECOS Enrollment IDI20170522000933
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.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
283 services156 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
91 services91 patients
Annual depression screening, 5 to 15 minutes G0444
An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.
48 services48 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
20 services20 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
18 services18 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000
An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.
18 services15 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Henry Ford Macomb Hospital

Acute Care Hospitals · Clinton Township, MI
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230047
Location15855 Nineteen Mile RdClinton Township, MI 48038 · Macomb County
Emergency services Birthing friendly

Henry Ford Health Hospital

Acute Care Hospitals · Detroit, MI
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230053
Location2799 W Grand BlvdDetroit, MI 48202 · Wayne County
Emergency services Birthing friendly

Ascension St John Hospital

Acute Care Hospitals · Detroit, MI
2/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number230165
Location22101 Moross RdDetroit, MI 48236 · Wayne County
Emergency services Birthing friendly

Mclaren Macomb

Acute Care Hospitals · Mount Clemens, MI
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230227
Location1000 Harrington StMount Clemens, MI 48043 · Macomb County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48043 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
$134.28 typical visit price
range $58.04 – $177.36
Typical copayment $33.57 (range $14.51 – $44.34)
Most-billed visit code 99204
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.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
4 suppliers13 claims33 services$5.27 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
2 suppliers11 claims11 services$207.07 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

MR. ROBBIE WILLIAM ROESCH PA-C
Physician Assistant (Medical)
133 S MAIN ST
MOUNT CLEMENS, MI 48043
Macomb County (586) 468-1600
THOMAS A GIGNAC MD
Specialist
133 S MAIN ST, SUITE D
MOUNT CLEMENS, MI 48043
Macomb County (586) 465-1326
NICOLE MARIE SHIELDS PA-C
Physician Assistant (Medical)
133 S MAIN ST
MOUNT CLEMENS, MI 48043
Macomb County (586) 468-1600
ROBERT A CHANG MD
Internal Medicine
133 S MAIN ST
MOUNT CLEMENS, MI 48043
Macomb County (586) 468-1600
PETER A KOVALSZKI MD
Specialist
133 S MAIN ST, SUITE D
MOUNT CLEMENS, MI 48043
Macomb County (586) 465-1326
JOSEPH SCHERBA PA
Physician Assistant
133 S MAIN ST
MOUNT CLEMENS, MI 48043
Macomb County (586) 468-1600
FIRAS YAZIGI M.D.
Internal Medicine (Cardiovascular Disease)
133 S MAIN ST
MOUNT CLEMENS, MI 48043
Macomb County (586) 468-1600
INTERNAL MEDICINE ASSOCIATES OF MT. CLEMENS, PC
Internal Medicine
133 S MAIN ST
MOUNT CLEMENS, MI 48043
Macomb County (586) 468-1600

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 Tara Deryavoush's NPI number?

The NPI number for Tara Deryavoush is 1851718092. It was assigned to this individual provider in the NPPES registry on March 26, 2014.

Where is Tara Deryavoush located?

Tara Deryavoush practices at 133 S Main St, Mount Clemens, MI 48043. The listed phone number is (586) 468-1600.

What is Tara Deryavoush's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Tara Deryavoush enrolled in Medicare?

Yes. Tara Deryavoush 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.

What insurance does Tara Deryavoush accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 2 other insurers list Tara Deryavoush 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.

Is Tara Deryavoush affiliated with any hospitals?

According to CMS data, Tara Deryavoush is affiliated with Henry Ford Macomb Hospital, Henry Ford Health Hospital, Ascension St John Hospital and Mclaren Macomb.

When was this NPI record last updated?

The NPPES record for Tara Deryavoush was last updated on July 21, 2022. 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.