CARL RAY DETTWILER (MD) – Specialist, NPI 1285623819

CARL RAY DETTWILER (MD) is a healthcare provider. based in Lewiston, Idaho. specializing in GASTROENTEROLOGY. They hold the professional credentials MD. They hold a License No. M5110 (ID). The NPI Number for CARL RAY DETTWILER (MD) is 1285623819

Main info

Male
45 Years Of Experience
Accepts Medicare Assignment
Name
CARL RAY DETTWILER (MD)
NPI
1285623819
Phone
(208) 743-4373
Address
2517 17TH ST
Enumeration Date
17 October 2005
Last Update Date
16 December 2025

Doctor Profile

Medical School Name
LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2087434373
Graduation Year
1981 (45 years ago)
PAC ID
2769457852
Group Practice PAC ID
4587800560
Professional Enrollment ID
I20040907000488
Address ID
ID835016311LE2517XBXXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience64
Completeness85
Years active:20State licenses:1Digital endpointsOther names

76 GASTROENTEROLOGY in ID

Provider Addresses for CARL RAY DETTWILER (MD)

  • 2517, 17th Street, Lewiston, Nez Perce County, Idaho, 83501, United States

    SUITE B

    LEWISTON, ID 835016311

    Phone: (208) 743-4373

    Fax: (208) 743-3369

    Type: Mailing

  • 2517 17TH SREET

    SUITE B

    LEWISTON, ID 835010001

    Phone: (208) 743-4373

    Fax: (208) 743-3369

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 10 Open Payments records for all available years, with a total value of $383.

Total Amount is formed as General ($383) + Research ($0) + Ownership ($0) = $383.

Last reported payment date: 2024-11-05 • Largest payer in this snapshot: Janssen Biotech, Inc. ($153).

Total Amount

$383

General + Research + Ownership

Payments

10

Total payment records

General Amount

$383

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-05

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-10-13

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040907000488IGastroenterologyIDTBD
I20041013000375IGastroenterologyWATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
G0500Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monito678536$0
45385Removal of polyps or growths of large bowel using an endoscope with mechanical snare214210$0
43239Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope212206$0
43248Insertion of guide wire with dilation of esophagus using a flexible endoscope163126$0
45380Biopsy of large bowel using a flexible endoscope150149$0
View full utilization report →

Insurance plans in this area (ZIP 83501)

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Provider's Procedures

CARL RAY DETTWILER (MD) performs procedures in GASTROENTEROLOGY. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
GASTROENTEROLOGYID45378Diagnostic examination of large bowel using an endoscope1616
GASTROENTEROLOGYID45385Removal of polyps or growths of large bowel using an endoscope8585

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4587800560View full group profile
NameSpecialtyState
Nurse PractitionerWA

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Frequently asked questions

What number should I use to identify CARL RAY DETTWILER (MD) for billing?
Administrative and clinical systems typically use NPI 1285623819 for CARL RAY DETTWILER (MD).
Quick check: is CARL RAY DETTWILER (MD) active?
Public NPPES data shows CARL RAY DETTWILER (MD) with an active NPI status right now.
What does the directory say CARL RAY DETTWILER (MD) does?
Insurance directories may phrase it differently, but here CARL RAY DETTWILER (MD) maps to Other Service Providers. Clinical services aligned with this taxonomy classification.
Can patients visit CARL RAY DETTWILER (MD) in Lewiston, Idaho?
For routing, start with Lewiston, Idaho for CARL RAY DETTWILER (MD), then verify phone and hours locally.
Who maintains CARL RAY DETTWILER (MD)'s record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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