Donald Squires Dunevant, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01033863 Issued in IN

Practice address

3630 Willowcreek Rd
Portage, IN 46368-5075

Phone

(219) 759-5791

Fax

(219) 759-3807

NPI assigned

Mar 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cleanslate Medical Group of Indiana LLCGroup PAC ID 4880963909, 60 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Cleanslate Medical Group of Indiana LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Alexandria, IN
  • NPI 1023464294
  Medicare reassignment Care Compare group NPD
• Cleanslate Medical Group of Pennsylvania LLC

  • Multi-Specialty Clinic/Center
  • Wilkes Barre, PA
  • NPI 1184177263
  NPD (past)

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557964800000",
    "number": "1821059148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685075",
            "telephone_number": "219-759-1157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685075",
            "telephone_number": "219-759-5791",
            "fax_number": "219-759-3807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNEVANT",
        "first_name": "DONALD",
        "middle_name": "SQUIRES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2019-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01033863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "080106826",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5251392",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000522003",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100188440A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah J Dorsch, FNP
• Brian H Dortmund, MSW
• Lavita Douglas
• Belinda A Duffee, MS, OTR
• Kathryn Dumortier, PTA
• Dycora Transitional Health - Portage LLC
• Carol J Earl, COTA
• Amber L Edwards, SLP
• Joshua Eggleston, PTA
• Robert Engelhardt

• Family Medicine Physician in Portage, IN
• Providers in Portage, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.