Shawn F Bode, MD
Individual provider Active NPI Family Medicine Physician · Cromwell, MN
NPI 1154324820 · NPPES record last updated Jan 13, 2023
Key facts
- NPI
- 1154324820
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 40644 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- 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 PLLC
Practice addresses (Care Compare)
1197 Villa Vista Cir
Cromwell, MN 55726
Phone (218) 644-3331
PO Box
Suite 116
Cromwell, MN 55726
Hospital & facility affiliations
- St Croix Hospice
- Essentia Health Moose Lake
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080910000600 | MN | Practitioner - Family Practice | 6406768787 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cromwell Medical Clinic PLLC | Current |
Accepting new patients | |
| Dermatology Professionals, PA | Past |
Accepting new patients |
Locations
5565 Highway 210
Cromwell, MN 55726
Phone (218) 485-8123
5568 Clark Ave
Ste 1
Cromwell, MN 55726
Phone (218) 644-3811
Interoperability endpoints
- https://api.platform.athenahealth.com/13291/brand/1/csg/1/fhir/r4
- shawn.bode.1@13291.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 40644 | MN | Yes |
Addresses
Primary practice location
5568 Clark Avenue
Suite 1
Cromwell, MN 55726-0116
Mailing address
PO Box 116
Cromwell, MN 55726-0116
Phone (218) 644-3811
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 128716800 | Medicaid | MN |
Other providers in Cromwell, MN
- Susan W. Benzie
- Cromwell Medical Clinic PLLC
- Cromwell Wright Area Fire District
- Gateway Family Health Clinic, LTD.
- Kelly J. Goeb
- Marcia Lillian Pocernich
All providers in Cromwell, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.