NPIMap

Individual provider Active NPI

Paul R. Dewey, M.D.

  • Internal Medicine Physician
  • Moose Lake, MN
National Provider Identifier
1760485387
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
43634 Issued in MN
Practice address
4570 Cty. Hwy. 61
Moose Lake, MN 55767
Phone
(218) 485-4491
Fax
(218) 485-4724
NPI assigned
May 27, 2005
Last updated
Dec 4, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 43634 MN Primary
Pediatrics Physician 208000000X 43634 MN

Addresses

Primary practice location

4570 Cty. Hwy. 61
Moose Lake, MN 55767

Mailing address

4570 Cty. Hwy. 61
Moose Lake, MN 55767
Phone (218) 485-4491

Other identifiers 1

IdentifierTypeStateIssuer
792640500MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20100505000906 MN Practitioner - Internal MedicinePractitioner - Pediatric Medicine 8729990007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Minnesota Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians

Practice addresses (Care Compare)

1600 Miller Trunk Hwy
BLDG C
Duluth, MN 55811-5640
Phone (218) 786-5360

4570 Cty Hwy 61
Moose Lake, MN 55767-9401
Phone (218) 485-4491

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43634MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Family Health Clinic, LTD. Internal Medicine CurrentSince Aug 1, 2001 Accepting new patients
Gateway Family Health Clinic, LTD. Current Accepting new patients
Gateway Family Health Clinic, LTD. Internal Medicine Past Accepting new patients

Locations

707 Lundorff Dr
#1
Sandstone, MN 55072
Phone (320) 245-2250

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDGJBA
  • Direct secure messaging: paul.dewey@gfhc.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Gateway Family Health Clinic, LTD.Sandstone, MN, CCN 243859 Rural health clinic 5% Or Greater Direct Ownership Interest (9.09%)
General Partnership Interest (9.09%)
Corporate Director
W-2 Managing Employee (9.09%)		 Feb 1, 2003
Feb 1, 2003
Jan 1, 2020
Feb 1, 2003

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 4

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 30

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1760485387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 CTY. HWY. 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "55767",
            "telephone_number": "218-485-4491",
            "fax_number": "218-485-4724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 CTY. HWY. 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "55767",
            "telephone_number": "218-485-4491",
            "fax_number": "218-485-4724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWEY",
        "first_name": "PAUL",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "43634",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "43634",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "792640500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moose Lake, MN

Sources for this page

Verify at the official NPI Registry.