Jeannine Misutka Dodds
Individual provider Active NPI Physician Assistant · Cincinnatus, NY
NPI 1043412976 · NPPES record last updated Apr 28, 2022
Key facts
- NPI
- 1043412976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 012300 (NY)
- Practice address
- 2809 Cincinnatus Rd
Cincinnatus, NY 13040-9685 - Phone
- (607) 863-3200
- Fax
- (607) 863-3455
- NPI assigned
- Jun 4, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201228002451 | NY | Practitioner - Physician Assistant | 4486892395 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012300 | NY | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Network of Central New York, Inc. | Current |
Accepting new patients | |
| Family Health Network of Central New York, Inc. | Physician Assistant | Current |
Accepting new patients |
Locations
2809 Cincinnatus Rd
Cincinnatus, NY 13040
Phone (607) 863-3200
711 Railroad St
De Ruyter, NY 13052
Phone (315) 852-3400
85 S West St
Homer, NY 13077
Phone (607) 753-3797
Interoperability endpoints
- jeannine.dodds.1@28343.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 012300 | NY | Yes |
Addresses
Primary practice location
2809 Cincinnatus Rd
Cincinnatus, NY 13040-9685
Mailing address
85 South West Street
Homer, NY 13077-0000
Phone (607) 753-3797
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03433754 | Medicaid | NY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Homer | Health Information Exchange (HIE) | |
| CONNECT URL | Homer | Health Information Exchange (HIE) |
Other providers in Cincinnatus, NY
- Cincinnatus Central School District
- Cincinnatus Fire District
- Crystal Ann Clough
- Tayler Lynne Marie Constantino
- Elizabeth Coon
- Family Health Network of Central New York, Inc
- Family Health Network of Central New York, Inc
- Allison Claire Field
- Robyn Garcia
- Casey Lee Holtslander
All providers in Cincinnatus, NY · Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2022. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.