Shawn F Bode, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

40644 Issued in MN

Practice address

5568 Clark Avenue
Suite 1
Cromwell, MN 55726-0116

Phone

(218) 644-3811

Fax

(218) 644-3813

NPI assigned

May 24, 2005

Last updated

Jan 13, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Minnesota Medical School, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cromwell Medical Clinic PLLCGroup PAC ID 5890861173, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Croix Hospice Hospice, Moose Lake, MN, CCN 241629
• Essentia Health Moose Lake Hospital, Moose Lake, MN, CCN 241350

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13291/brand/1/csg/1/fhir/r4
• Direct secure messaging: shawn.bode.1@13291.direct.athenahealth.com

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.

• Cromwell Medical Clinic PLLC

  • Primary Care Clinic/Center
  • Cromwell, MN
  • NPI 1821250549
  Medicare reassignment Care Compare group NPD Authorized official
• Dermatology Professionals, PA

  • Clinic/Center
  • Baxter, MN
  • NPI 1720269426
  NPD (past)

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

• Essentia Health Moose Lake

  • Critical Access Hospital
  • Moose Lake, MN
  • NPI 1154959880
  Care Compare affiliation
• Essentia Health Moose Lake

  dba Essentia Health Moose Lake Clinic

  • Critical Access Hospital Clinic/Center
  • Moose Lake, MN
  • NPI 1275102048
  Care Compare affiliation
• STCH Moose Lake Opco LLC

  dba St Croix Hospice

  • Community Based Hospice Care Agency
  • Moose Lake, MN
  • NPI 1982463139
  Care Compare affiliation

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1154324820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116",
            "city": "CROMWELL",
            "state": "MN",
            "postal_code": "557260116",
            "telephone_number": "218-644-3811",
            "fax_number": "218-644-3813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5568 CLARK AVENUE",
            "address_2": "SUITE 1",
            "city": "CROMWELL",
            "state": "MN",
            "postal_code": "557260116",
            "telephone_number": "218-644-3811",
            "fax_number": "218-644-3813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODE",
        "first_name": "SHAWN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "40644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128716800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan W. Benzie, M.D.
• Cromwell Medical Clinic PLLC
• Cromwell Wright Area Fire District
• Gateway Family Health Clinic, LTD.
• Kelly J. Goeb, M.D.
• Marcia Lillian Pocernich, PT

• Family Medicine Physician in Cromwell, MN
• Providers in Cromwell, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.