NPIMap

Individual provider Active NPI

Dawn R Back, PA

  • Physician Assistant
  • Santa Rosa, NM
National Provider Identifier
1841273554
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2016-0044 Issued in NM
Practice address
117 Camino de Vida
Suite 300
Santa Rosa, NM 88435
Phone
(575) 472-4311
Fax
(575) 472-4313
NPI assigned
Nov 28, 2005
Last updated
Feb 8, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2016-0044 NM Primary
Physician Assistant 363A00000X 2103 AK
Physician Assistant 363A00000X PA.0003777 CO

Addresses

Primary practice location

117 Camino de Vida
Suite 300
Santa Rosa, NM 88435

Mailing address

117 Camino de Vida
Suite 300
Santa Rosa, NM 88435
Phone (575) 472-4311

Other identifiers 1

IdentifierTypeStateIssuer
54452015MedicaidNM

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
I20251023001803 MN Practitioner - Physician Assistant 3173705357 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aitkin Community Hospital IncGroup PAC ID 4981514692, 96 clinicians
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians

Practice addresses (Care Compare)

200 Bunker Hill Dr
Aitkin, MN 56431-1865
Phone (218) 927-2121

523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 828-7400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
13645MNMDPhysical Therapist
2103AKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Medical Center CurrentSince Aug 29, 2025 Accepting new patients
Aitkin Community Hospital, Inc. CurrentSince Dec 1, 2025 Accepting new patients
Glencoe Regional Health Services CurrentSince Jan 2, 2026 Accepting new patients
Glencoe Regional Health Services CurrentSince Jan 2, 2026 Accepting new patients
St Joseph's Medical Center CurrentSince Aug 29, 2025 Accepting new patients
Mille Lacs Health System Current Accepting new patients
St. Joseph's Medical Center Current Accepting new patients
Mille Lacs Health System CurrentSince Jun 9, 2025 Accepting new patients
Aitkin Community Hospital, Inc. CurrentSince Dec 1, 2025 Accepting new patients
Mille Lacs Health System Physician Assistant CurrentSince Jun 9, 2025 Accepting new patients
Aitkin Community Hospital, Inc. Past Accepting new patients

Locations

200 Bunker Hill Dr
Aitkin, MN 56431
Phone (218) 927-2121

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

1805 Hennepin Ave N
Glencoe, MN 55336
Phone (320) 864-3121

200 Elm St N
Onamia, MN 56359
Phone (320) 532-2750

Organizations & group practices 11

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1841273554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 CAMINO DE VIDA",
            "address_2": "SUITE 300",
            "city": "SANTA ROSA",
            "state": "NM",
            "postal_code": "88435",
            "telephone_number": "575-472-4311",
            "fax_number": "575-472-4313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 CAMINO DE VIDA",
            "address_2": "SUITE 300",
            "city": "SANTA ROSA",
            "state": "NM",
            "postal_code": "88435",
            "telephone_number": "575-472-4311",
            "fax_number": "575-472-4313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACK",
        "first_name": "DAWN",
        "middle_name": "R",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-28",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2016-0044",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "2103",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0003777",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54452015",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, NM

Sources for this page

Verify at the official NPI Registry.