Jake Daniel Dodge, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

SL1306 Issued in NV

Practice address

4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600

Phone

(915) 540-1431

NPI assigned

Jun 8, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

U S Health Dept of Health and Human ServicesGroup PAC ID 9638081623, 98 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• P H S Indian Hospital at Browning - Blackfeet Hospital, Browning, MT, CCN 270074
• Northern Rockies Medical Center Hospital, Cut Bank, MT, CCN 271337

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• US Health Dept of Health & Human Services

  • Rural Health Clinic/Center
  • Poplar, MT
  • NPI 1972694602

  TX

  Medicare reassignment Care Compare group NPD
• U S Health Dept of Health & Human Services

  • Critical Access Hospital
  • Lodge Grass, MT
  • NPI 1750410395
  NPD
• U S Health Dept of Health & Human Services

  • General Acute Care Hospital
  • Browning, MT
  • NPI 1861409955
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northern Rockies Medical Center, Inc.

  • Critical Access Hospital
  • Cut Bank, MT
  • NPI 1831143080
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1114410784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "915-540-1431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "915-540-1431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10350 E Dakota Ave",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802471314",
            "country_code": "US",
            "telephone_number": "303-338-4545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DODGE",
        "first_name": "JAKE",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-08",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0069622",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "SL1306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER COMMERCIAL NUMBER",
            "identifier": "029551",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA STATE LICENSING BOARD",
            "identifier": "SL1306",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10350 E Dakota Ave",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802471314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Navdeep Dhaliwal, M.D.
• Rebecca Rose Difabio, MD
• Gary T Dirisio, PHARM D
• Caleb Nance Dixon, DO
• DO Karen Worzel, LLC
• Joshua Dodge, MD
• Danielle M Dombrowski, M.D.
• Joanne Marie Dominguez, PHARMD
• Kristen Dorazio, DO
• Malcolm Douglas, PA

• Family Medicine Physician in Nellis Afb, NV
• Providers in Nellis Afb, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.