NPIMap

Individual provider Active NPI

Dennis Charles Spano, M.D.

  • Family Medicine Physician
  • Lake City, MN
National Provider Identifier
1033195656
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36426 Issued in MN
Practice address
500 W Grant St
Lake City, MN 55041-1143
Phone
(651) 345-3321
Fax
(651) 345-1151
NPI assigned
Dec 15, 2005
Last updated
Oct 1, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36426 MN Primary

Addresses

Primary practice location

500 W Grant St
Lake City, MN 55041-1143

Mailing address

1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-5600

Other identifiers 6

IdentifierTypeStateIssuer
925515000MedicaidMN
0113159OtherMEDICA
MH9101008904OtherPREFERRED ONE
080125255OtherRAILROAD MEDICARE
49A86SPOtherBCBS
118169OtherUCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100115000147 MN Practitioner - Family Practice 2860486834 Reassigns benefits to 3 organizations
I20181019000023 WI Practitioner - Family Practice 2860486834 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-4531

1836 S Ave
La Crosse, WI 54601-5429
Phone (608) 783-7300

204 S Main St
Alma, WI 54610-7722
Phone (651) 565-5599

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Apr 1, 2017 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
St Francis Regional Medical Center CurrentSince Jan 25, 2017 Accepting new patients
St. Francis Regional Medical Center CurrentSince Jan 25, 2017 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Sep 1, 2018 Accepting new patients
Minnesota Valley Health Center Inc Current Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Oct 9, 2023 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Oct 9, 2023 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Apr 1, 2017 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc Past Accepting new patients

Locations

265 Creek Ln S
Jordan, MN 55352
Phone (952) 428-1200

621 S 4th St
Le Sueur, MN 56058
Phone (507) 665-3375

8170 Old Carriage Ct
Ste 100
Shakopee, MN 55379
Phone (952) 428-3600

1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

Interoperability endpoints

  • Direct secure messaging: dspano472623@direct.emplifyhealth.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Gundersen St Elizabeth's Care CenterWabasha, MN, CCN 245487 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Mar 3, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1033195656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 GRANT BLVD W",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559811042",
            "telephone_number": "651-565-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W GRANT ST",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411143",
            "telephone_number": "651-345-3321",
            "fax_number": "651-345-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPANO",
        "first_name": "DENNIS",
        "middle_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "36426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "925515000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0113159",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "MH9101008904",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080125255",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "49A86SP",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "118169",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, MN

Sources for this page

Verify at the official NPI Registry.