Carl Ray Dettwiler, MD
Individual provider Active NPI Specialist · Lewiston, ID
NPI 1285623819 · NPPES record last updated Dec 16, 2025
Key facts
- NPI
- 1285623819
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- M5110 (ID)
- Practice address
- 2517 17TH Sreet
Suite B
Lewiston, ID 83501-0001 - Phone
- (208) 743-4373
- Fax
- (208) 743-3369
- NPI assigned
- Oct 17, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 17
Medicare Care Compare profile
- Specialty
- Gastroenterology
- Education
- Loma Linda University School of Medicine, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Clearwater Gastroenterology
Practice addresses (Care Compare)
1221 Highland Ave
Clarkston, WA 99403-2829
Phone (509) 758-5511
2517 17TH St B
Lewiston, ID 83501-6311
Phone (208) 743-4373
Hospital & facility affiliations
- St Joseph Regional Medical Center
- Tri-State Memorial Hospital
- Clearwater Valley Hospital & Clinics
- St Mary'S Hospital
- Gritman Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 80.33 of 100
- Quality
- 67.67
- Improvement activities
- 40
- Cost
- 77.55
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 246 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 439 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID, WA
- 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 |
|---|---|---|---|---|
| I20040907000488 | ID | Practitioner - Gastroenterology | 2769457852 | Reassigns benefits to 1 organization |
| I20041013000375 | WA | Practitioner - Gastroenterology | 2769457852 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M5110 | ID | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clearwater Gastroenterology | Specialist | Current |
Accepting new patients |
| St. Joseph Hospital, LLC | Past | Accepting new patients | |
| Lewis Clark Gastroenterology PLLC | Past |
Accepting new patients | |
| Gem State Endoscopy | Past |
Accepting new patients |
Locations
3709 14th St
Lewiston, ID 83501
Phone (208) 298-2141
2517 17th St
Ste B
Lewiston, ID 83501
Phone (208) 743-3563
1221 Highland Ave
Clarkston, WA 99403
Phone (509) 751-0312
1221 Highland Ave
#H
Clarkston, WA 99403
Phone (509) 758-5511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | M5110 | ID | Yes |
Addresses
Primary practice location
2517 17TH Sreet
Suite B
Lewiston, ID 83501-0001
Mailing address
2517 17TH St
Suite B
Lewiston, ID 83501-6311
Phone (208) 743-4373
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806979100 | Medicaid | ID |
Other names
- Prof. Carl Ray Dettwiler
Other providers in Lewiston, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2025. 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.