Stephen E Davis, MD
Individual provider Active NPI Family Medicine Physician · Wadena, MN
NPI 1699882001 · NPPES record last updated Jun 1, 2015
Key facts
- NPI
- 1699882001
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 33510 (MN)
- Practice address
- 4 Deerwood Ave NW
Wadena, MN 56482-1253 - Phone
- (218) 631-1360
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 3
Owned or controlled facilities with NPI records 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Minnesota Medical School, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Astera Health
Practice addresses (Care Compare)
415 Jefferson N St
Wadena, MN 56482-1264
415 Jefferson St N
Wadena, MN 56482-1264
Phone (218) 631-7495
Hospital & facility affiliations
- Vivie Home Health
- Astera Health
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
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Astera Health |
Hospital | Corporate Director | Jan 1, 2021 |
| Astera Health |
Hospital | Corporate Director | Jan 1, 2021 |
| Astera Health Sebeka Clinic |
Rural health clinic | Corporate Director | Jan 1, 2021 |
| Astera Health Henning Clinic |
Rural health clinic | Corporate Director | Jan 1, 2021 |
| Astera Health Ottertail Clinic |
Rural health clinic | Corporate Director | Jan 1, 2021 |
| Astera Health Verndale Clinic |
Rural health clinic | Corporate Director | Jul 1, 1992 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080129000429 | MN | Practitioner - Family Practice | 5395715148 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33510 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Astera Health | Current | Accepting new patients | |
| Astera Health | Current |
Accepting new patients | |
| Wadena Medical Center, LTD | Family Medicine | Past |
Accepting new patients |
Locations
421 11th St NW
Wadena, MN 56482
Phone (218) 631-3510
415 Jefferson St N
Wadena, MN 56482
Phone (218) 631-3510
4 Deerwood Ave NW
Wadena, MN 56482
Phone (218) 631-1100
Interoperability endpoints
- sdavis13037@direct.centracare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 33510 | MN | Yes |
Addresses
Primary practice location
4 Deerwood Ave NW
Wadena, MN 56482-1253
Mailing address
415 Jefferson St N
Wadena, MN 56482-1264
Phone (218) 631-3510
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 867203200 | Medicaid | MN |
Other providers in Wadena, MN
- Charity Joy-Klebs Crosby
- Meghan Current-Cary
- Dawn Dahlgren-Roemmich
- Jill Lynette Davis
- Robert P. Davis
- Miriam A Decock
- Vickie L Dennis
- Sulma Disselbrett
- Katherine Claire Dittmann
- Pam J Doebbeling
All providers in Wadena, 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 Jun 1, 2015. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.