NPIMap

Individual provider Active NPI

Michael Cloos, D.O.

  • Family Medicine Physician
  • De Witt, IA
National Provider Identifier
1750761383
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO-04887 Issued in IA
Practice address
1415 11TH St Ste C
De Witt, IA 52742-1292
Phone
(563) 659-6090
Fax
(866) 493-4063
NPI assigned
Jun 9, 2015
Last updated
May 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2024

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 DO-04887 IA Primary

Addresses

Primary practice location

1415 11TH St Ste C
De Witt, IA 52742-1292

Mailing address

1415 11TH St Ste C
De Witt, IA 52742-1292
Phone (563) 659-6090

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address admin@dewittfamilypractice.com Direct

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
I20180630000151 IA Practitioner - Family Practice 8820301773 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dewitt Family Practice PLLCGroup PAC ID 1850738592, 5 clinicians

Practice addresses (Care Compare)

1415 11TH St
Suite C
De Witt, IA 52742-1292
Phone (563) 659-6090

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions44
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy22

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health System CurrentSince Jul 30, 2018 Accepting new patients
Genesis Health System Single Specialty Current Accepting new patients
Genesis Health System Single Specialty CurrentSince Jul 30, 2018 Accepting new patients
Dewitt Family Practice, PLLC Single Specialty CurrentSince Feb 5, 2024 Accepting new patients
Laboratory Corporation of America Holdings Past Accepting new patients

Locations

1351 W Central Park Ave
Ste 4100
Davenport, IA 52804
Phone (563) 355-9191

210 W 53rd St
Davenport, IA 52806
Phone (563) 386-3436

1008 11th St
De Witt, IA 52742
Phone (563) 659-9137

1415 11th St
Ste C
De Witt, IA 52742
Phone (563) 659-6090

2422 12th Street Ct
De Witt, IA 52742
Phone (563) 659-6090

619 5th St
Durant, IA 52747
Phone (563) 785-4487

Interoperability endpoints

  • Direct secure messaging: michael.cloos@direct.genesishealth.com

Organizations & group practices 6

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 4

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": "1433808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1750761383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 11TH ST STE C",
            "city": "DE WITT",
            "state": "IA",
            "postal_code": "527421292",
            "telephone_number": "563-659-6090",
            "fax_number": "866-493-4063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 11TH ST STE C",
            "city": "DE WITT",
            "state": "IA",
            "postal_code": "527421292",
            "telephone_number": "563-659-6090",
            "fax_number": "866-493-4063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOOS",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-09",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "DO-04887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@dewittfamilypractice.com",
            "affiliation": "N",
            "endpointDescription": "DeWitt Family Practice direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1415 11th St Ste C",
            "city": "DE Witt",
            "state": "IA",
            "country_code": "US",
            "postal_code": "527421292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in De Witt, IA

Sources for this page

Verify at the official NPI Registry.