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CARL RAY DETTWILER MD NPI 1285623819


NPI Information

NPI: 1285623819
Provider Name: CARL RAY DETTWILER, MD
Classification: Specialist - 174400000X
Entity Type: Individual
Organization: CLEARWATER GASTROENTEROLOGY

PECOS Registration: Yes

Address:
2517 17TH SREET
SUITE B
LEWISTON, ID
ZIP 83501
Phone: (208) 743-4373
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Carl Ray Dettwiler, MD is a specialist in Lewiston, ID with 43 years of experience. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. Carl Ray Dettwiler, MD NPI is 1285623819. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1981

The provider's business location address is:

2517 17TH SREET
SUITE B
LEWISTON, ID
ZIP 83501-001
Phone: (208) 743-4373
Fax: (208) 743-3369

The NPI 1285623819 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope (HCPCS:43239)
  • Removal of polyps or growths of large bowel using an endoscope (HCPCS:45385)
  • Biopsy of large bowel using an endoscope (HCPCS:45380)
  • Diagnostic examination of large bowel using an endoscope (HCPCS:45378)

The enumeration date for this NPI number is 10/17/2005 and was last updated on 2/13/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistM5110IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1806979100MEDICAIDIDAHO
2P00206501MEDICARE PIN
31118867MEDICARE PIN
48807791MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.