Mikayla Marie Van Dervoort, PA-C
NPI 1649014614ActiveIndividual· Physician Assistant· Saugus, MA
Physician Assistant (PA-C) with Convenientmd - Ffs Uc LLC and 1 other group, practicing in Saugus, Massachusetts. Mostly services rather than prescriptions: Medicare paid $5,605 for 51 patients in 2024, with only 41 Part D claims. Lists Tufts Medical Center as a hospital affiliation.
Overview
| NPI | 1649014614 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA-C |
| Sole proprietor | Yes |
| NPI issued | Jun 24, 2024 |
| Last updated in NPPES | Sep 16, 2024 |
| Certified by provider | Sep 16, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (MA) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 51 |
|---|---|
| Services billed | 100 across 21 procedure codes |
| Paid by Medicare | $5,605 |
Part D prescriptions in 2024
| Prescriptions (claims) | 41 · 41 30-day fills |
|---|---|
| Patients | 30 |
| Total drug cost | $310.15 |
| Generic share | 90% of claims |
Education and affiliations
| Graduation year | 2024 |
|---|---|
| Medicare specialty | Physician Assistant |
| Telehealth | Offers telehealth |
Medical groups
- Convenientmd - Ffs Uc LLCStratham, NH · 392 clinicians
- Pratt Medical Group IncBoston, MA · 286 clinicians
Hospital affiliation
- Tufts Medical CenterBoston, MA
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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