Dr Derrick Mikel Outlaw, DPT is a medicare enrolled "Physical Medicine & Rehabilitation" physician in Niles, Michigan. His current practice location is
2882 Detroit Rd, Niles, Michigan. You can reach out to his office (for appointments etc.) via phone at
(574) 333-8775.
Dr Derrick Mikel Outlaw is licensed to practice in Michigan (license number 5501018789) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1396219663.
Physician's Profile
Full Name | Dr Derrick Mikel Outlaw |
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Gender | Male |
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Speciality | Physical Medicine & Rehabilitation |
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Location | 2882 Detroit Rd, Niles, Michigan |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1396219663
- Provider Enumeration Date: 01/18/2019
- Last Update Date: 09/08/2021
Medicare PECOS Information:
- PECOS PAC ID: 8628423332
- Enrollment ID: I20231016003656
Medical Identifiers
Medical identifiers for Dr Derrick Mikel Outlaw such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1396219663 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
208100000X | Physical Medicine & Rehabilitation | 5501018789 (Michigan) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Derrick Mikel Outlaw allows following entities to bill medicare on his behalf.
Entity Name | Sutter Bay Medical Foundation |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1013950807 PECOS PAC ID: 4284538778 Enrollment ID: O20031125000909 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Derrick Mikel Outlaw is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Derrick Mikel Outlaw, DPT 2882 Detroit Rd, Niles, MI 49120-9412 Ph: (574) 333-8775 | Dr Derrick Mikel Outlaw, DPT 2882 Detroit Rd, Niles, MI 49120-9412 Ph: (574) 333-8775 |
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