NPIMap

Individual provider Active NPI

Paul Edward Dudley, M.D.

  • Family Medicine Physician
  • Onawa, IA
National Provider Identifier
1194721332
Registry record updated Oct 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
29427 Issued in IA
Practice address
1614 Diamond Street PL
Onawa, IA 51040-1554
Phone
(712) 423-1525
Fax
(712) 423-2528
NPI assigned
Jun 22, 2005
Last updated
Oct 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2007

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 29427 IA Primary

Addresses

Primary practice location

1614 Diamond Street PL
Onawa, IA 51040-1554

Mailing address

1614 Diamond Street PL
Onawa, IA 51040-1554
Phone (712) 423-1525

Other identifiers 3

IdentifierTypeStateIssuer
0100842MedicaidIA
12602OtherIABLUE SHIELD OF IOWA
080057253OtherIARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20090218000447 IA Practitioner - Family Practice 8820091119 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Burgess Health CenterGroup PAC ID 0143131516, shared by 7 NPIs, 13 clinicians
Family Medicine Clinic, P.C.Group PAC ID 0547159824, 10 clinicians

Practice addresses (Care Compare)

1600 Diamond St
Onawa, IA 51040-1548
Phone (712) 423-2311

1614 Diamond St PL
Onawa, IA 51040-1554
Phone (712) 423-1525

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29427IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medicine Clinic, PC Family Medicine CurrentSince Aug 17, 1993 Accepting new patients
Family Medicine Clinic, P.C. Family Medicine CurrentSince Aug 17, 1993 Accepting new patients
Burgess Health Center Family Medicine CurrentSince Jan 1, 2008 Accepting new patients
Burgess Health Center CurrentSince Jan 1, 2008 Accepting new patients
Burgess Health Center Current Accepting new patients

Locations

1600 Diamond St
Onawa, IA 51040
Phone (712) 423-2311

1614 Diamond Street Pl
Onawa, IA 51040
Phone (712) 423-1525

Interoperability endpoints

  • Direct secure messaging: pauldudley@fmcc.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Burgess Health CenterOnawa, IA, CCN 161359 Hospital Contracted Managing Employee
Corporate Director
Operational/Managerial Control		 Jun 14, 2017
Jun 22, 2009
Jun 4, 2017
Burgess Health CenterOnawa, IA, CCN 16Z359 Hospital Contracted Managing Employee
Corporate Director
Operational/Managerial Control		 Jun 14, 2017
Jun 22, 2009
Jun 14, 2017
Accura Healthcare of OnawaOnawa, IA, CCN 165256 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2025
Feb 1, 2025
Casa de Paz Health Care CenterSioux City, IA, CCN 165174 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2025
Feb 1, 2025
Burgess Home HealthOnawa, IA, CCN 167146 Home health agency Corporate Director Jun 22, 2009
Burgess HospiceOnawa, IA, CCN 161539 Hospice Corporate Director Jun 22, 2009
Family Medicine Clinic, P.C.Onawa, IA, CCN 163831 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
General Partnership Interest (25%)		 Jul 1, 1970
Jun 1, 2022
Burgess Family Clinic - Maple ValleyMapleton, IA, CCN 168538 Rural health clinic Corporate Director Jun 22, 2009
Burgess Family Clinic - SloanSloan, IA, CCN 163483 Rural health clinic Corporate Director Jun 22, 2009

Owned or controlled facilities with NPI records 9

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

Organizations & group practices 5

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 7

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191801600000",
    "number": "1194721332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 DIAMOND STREET PL",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510401554",
            "telephone_number": "712-423-1525",
            "fax_number": "712-423-2528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 DIAMOND STREET PL",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510401554",
            "telephone_number": "712-423-1525",
            "fax_number": "712-423-2528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "PAUL",
        "middle_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2007-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "29427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100842",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IOWA",
            "identifier": "12602",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080057253",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Onawa, IA

Sources for this page

Verify at the official NPI Registry.