NPIMap

Individual provider Active NPI

Shivali Devgon, MD

  • Internal Medicine Physician
  • Roseau, MN
National Provider Identifier
1154632503
Registry record updated Mar 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
56155 Issued in MN
Practice address
711 Delmore Dr
Roseau, MN 56751-1534
Phone
(218) 463-1365
Fax
(218) 463-3928
NPI assigned
Jun 30, 2010
Sex
Female
Sole proprietor
No

Organizations & group practices 24

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

View all 24

Hospital & facility affiliations 5

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

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Altru Health System 675 clinicians
Lifecare Medical Center 55 clinicians

Practice addresses (Care Compare)

711 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-1365

715 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-2500

Hospital & facility affiliations

  • Lifecare Medical Center Home health agency, Roseau, MN, CCN 247094
  • Lifecare Medical Center Hospital, Roseau, MN, CCN 241344
  • Altru Hospital Hospital, Grand Forks, ND, CCN 350019
  • Lifeceare Roseau Manor Nursing home, Roseau, MN, CCN 245470
  • Lifecare Medical Center Nursing home, CCN 24Z344
  • Warroad Care Center Nursing home, Warroad, MN, CCN 245329

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20130705000447 MN Practitioner - Internal Medicine 9830339365 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Altru Health System Current Accepting new patients
Altru Health System CurrentSince Jul 1, 2013 Accepting new patients
Altru Health System CurrentSince Jul 1, 2013 Accepting new patients
Lifecare Medical Center Past Accepting new patients

Locations

19120 200th St
Greenbush, MN 56726
Phone (218) 782-2400

715 Delmore Dr
Roseau, MN 56751
Phone (218) 463-2500

711 Delmore Dr
Roseau, MN 56751
Phone (218) 463-1365

715 Delmore Dr
Ste 100
Roseau, MN 56751
Phone (218) 463-1365

412 Main Ave NE
Warroad, MN 56763
Phone (218) 386-2020

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 56155 MN Primary

Addresses

NPPES NPI Registry

Primary practice location

711 Delmore Dr
Roseau, MN 56751-1534

Mailing address

711 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-1365

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 31, 2014.

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396224000000",
    "number": "1154632503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511534",
            "telephone_number": "218-463-1365",
            "fax_number": "218-463-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511534",
            "telephone_number": "218-463-1365",
            "fax_number": "218-463-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVGON",
        "first_name": "SHIVALI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-30",
        "last_updated": "2014-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "56155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseau, MN

Sources for this page

Verify at the official NPI Registry.