NPIMap

Individual provider Active NPI

Elise K Dewey, PA-C

  • Physician Assistant
  • Farmington, MO
National Provider Identifier
1104659713
Registry record updated Oct 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2024039608 Issued in MO
Practice address
1103 W Liberty St
Farmington, MO 63640-1921
Phone
(573) 760-8090
Fax
(573) 760-8260
NPI assigned
Aug 21, 2024
Last updated
Oct 28, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2024039608 MO Primary

Addresses

Primary practice location

1103 W Liberty St
Farmington, MO 63640-1921

Mailing address

PO Box 959354
Saint Louis, MO 63195-9354
Phone (573) 760-8090

Other practice location 1

211 Saint Francis Dr
Cape Girardeau, MO 63703-5049
Phone (573) 331-5110

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241010000824 MO Practitioner - Physician Assistant 2769914183 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians
Ste Genevieve County Memorial HospitalGroup PAC ID 3274432802, shared by 9 NPIs, 74 clinicians

Practice addresses (Care Compare)

1103 W Liberty St
Farmington, MO 63640-1921
Phone (573) 756-6751

255 Boderman
Bloomsdale, MO 63627-9099
Phone (573) 483-9492

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2024039608MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC CurrentSince Nov 18, 2025 Accepting new patients
Physician Groups LC CurrentSince Nov 18, 2025 Accepting new patients
Saint Francis Medical Center CurrentSince Oct 3, 2024 Accepting new patients
Cape Laboratory & Pathology, LC Current Accepting new patients
Saint Francis Medical Center CurrentSince Oct 3, 2024 Accepting new patients

Locations

7245 Raider Rd
Ste C
Bonne Terre, MO 63628
Phone (573) 358-4600

211 Saint Francis Dr
Cpe Girardeau, MO 63703
Phone (573) 331-3000

1103 W Liberty St
Farmington, MO 63640
Phone (573) 760-8488

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

753 Pointe Basse Dr
Ste Genevieve, MO 63670
Phone (573) 883-2782

800 Ste Genevieve Dr
Ste Genevieve, MO 63670
Phone (573) 883-2571

Organizations & group practices 11

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 3

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": "1724198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761609600000",
    "number": "1104659713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959354",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959354",
            "telephone_number": "573-760-8090",
            "fax_number": "573-760-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 W LIBERTY ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401921",
            "telephone_number": "573-760-8090",
            "fax_number": "573-760-8260"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 Saint Francis Dr",
            "address_purpose": "LOCATION",
            "city": "Cape Girardeau",
            "state": "MO",
            "postal_code": "637035049",
            "country_code": "US",
            "telephone_number": "573-331-5110",
            "fax_number": "573-335-4689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEWEY",
        "first_name": "ELISE",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-21",
        "last_updated": "2025-10-28",
        "certification_date": "2025-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2024039608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1103 W Liberty St",
            "city": "Farmington",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636401921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.