NPIMap

Individual provider Active NPI

Jeffrey Lemoine Dunham, MD

  • Family Medicine Physician
  • Shell Lake, WI
National Provider Identifier
1841295862
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30726 Issued in WI
Practice address
113 4TH Avenue
Shell Lake, WI 54871
Phone
(715) 468-7833
Fax
(715) 468-7839
NPI assigned
Jun 16, 2005
Last updated
Jun 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 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 30726 WI Primary

Addresses

Primary practice location

113 4TH Avenue
Shell Lake, WI 54871

Mailing address

113 4TH Avenue
Shell Lake, WI 54871
Phone (715) 468-7833

Other identifiers 1

IdentifierTypeStateIssuer
31592800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20041006000469 WI Practitioner - Family Practice 4183518673 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

24670 State Rd
70 Suite 100
Siren, WI 54872-4419
Phone (715) 349-2910

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30726WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Indianhead Medical Center Shell Lake, Inc. CurrentSince Apr 1, 2017 Accepting new patients
Ladd Memorial Hospital CurrentSince Jun 1, 2025 Accepting new patients
Spooner Health System, Inc. Current Accepting new patients
Indianhead Medical Center Shell Lake, Inc CurrentSince Apr 1, 2017 Accepting new patients
Indianhead Medical Center Shell Lake, Inc. Current Accepting new patients
Ladd Memorial Hospital CurrentSince Jun 1, 2025 Accepting new patients

Locations

2600 65th Ave
Osceola, WI 54020
Phone (705) 268-8000

113 4th Ave
Shell Lake, WI 54871
Phone (715) 468-7833

24670 State Road 35 70
Ste 100
Siren, WI 54872
Phone (715) 349-2910

7728 Main St
Siren, WI 54872
Phone (715) 349-2910

1280 Chandler Dr
Spooner, WI 54801
Phone (715) 635-2111

Interoperability endpoints

  • Direct secure messaging: jeffreydunham@indmectr.allscriptsdirect.net

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
Dove Healthcare - SpoonerSpooner, WI, CCN 525673 Skilled nursing facility Contracted Managing Employee May 1, 2024

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 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 6

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": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1841295862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 4TH AVENUE",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "54871",
            "telephone_number": "715-468-7833",
            "fax_number": "715-468-7839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 4TH AVENUE",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "54871",
            "telephone_number": "715-468-7833",
            "fax_number": "715-468-7839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNHAM",
        "first_name": "JEFFREY",
        "middle_name": "LEMOINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "30726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31592800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shell Lake, WI

Sources for this page

Verify at the official NPI Registry.