Stephen William Lewellis, M.D., PH.D.
Individual provider Active NPI Dermatology Physician · Plover, WI
NPI 1891152641 · NPPES record last updated May 2, 2024
Key facts
- NPI
- 1891152641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 75498-20 (WI)
- Practice address
- 3750 Corporate Ave
Plover, WI 54467-3566 - Phone
- (715) 391-9774
- Fax
- (917) 277-4883
- NPI assigned
- Jan 25, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Dermatology
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3750 Corporate Ave
Plover, WI 54467-3566
Phone (715) 391-9774
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210812001557 | WI | Practitioner - Dermatology | 1658608112 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75498-20 | WI | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Above and Beyond Dermatology | Current |
Accepting new patients |
Locations
3750 Corporate Ave
Ste 1
Plover, WI 54467
3750 Corporate Ave
Plover, WI 54467
Phone (715) 391-9774
Interoperability endpoints
- stephen.lewellis.1@18758.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 65601 | MN | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dermatology Physician | 207N00000X | 75498-20 | WI | Yes |
Addresses
Primary practice location
3750 Corporate Ave
Plover, WI 54467-3566
Mailing address
3002 N 7TH St
Wausau, WI 54403-3003
Phone (715) 391-9774
Other practice location 1
425 Pine Ridge Blvd Ste 305
Wausau, WI 54401-4124
Phone (715) 847-2626
Other practice location 2
5121 S Cottonwood St
Murray, UT 84107-5701
Phone (801) 507-7000
Other practice location 3
9555 Upland Ln N
Maple Grove, MN 55369
Phone (952) 993-1440
Other providers in Plover, WI
- Larry Woods, OD
- Kimberley Louise Laube
- Alyssa Marie Lenze
- Leo O Powers Dba Powers Chiropractic
- Derek Leonard
- Eric James Liazuk
- Lotus Healing Arts LLC
- Kimberly Rae Loveland
- Wendy Ludtke
- Carlee L Lynch
All providers in Plover, WI · Dermatology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.