Individual provider Active NPI

John Douglas Calisesi, DC

  • Chiropractor
  • Fort Dodge, IA
National Provider Identifier
1467420380
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
IA4401 Issued in IA
Practice address
24 S 14TH St
Fort Dodge, IA 50501-4964
Phone
(515) 576-2183
Fax
(515) 576-2336
NPI assigned
Mar 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X IA4401 IA Primary

Addresses

Primary practice location

24 S 14TH St
Fort Dodge, IA 50501-4964

Mailing address

1945 15TH Ave N
Fort Dodge, IA 50501-7701
Phone (515) 955-2313

Other identifiers 2

IdentifierTypeStateIssuer
0489245MedicaidIA
0098392MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041119000599 IA Practitioner - Chiropractic 7719942622 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Calisesi Chiropractic Clinic PLLCGroup PAC ID 0648593889, 3 clinicians

Practice addresses (Care Compare)

24 S 14TH St
Fort Dodge, IA 50501-4964
Phone (515) 576-2183

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
IA4401IAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Calisesi Chiropractic Clinic, PLLC Chiropractor CurrentSince Jan 1, 2015 Accepting new patients

Locations

24 S 14th St
Fort Dodge, IA 50501
Phone (515) 576-2183

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295395200000",
    "number": "1467420380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 15TH AVE N",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505017701",
            "telephone_number": "515-955-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 S 14TH ST",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505014964",
            "telephone_number": "515-576-2183",
            "fax_number": "515-576-2336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALISESI",
        "first_name": "JOHN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2011-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "IA4401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0489245",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0098392",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Dodge, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.