Robert Thomas Dodge, PHD, RN, ANP
Individual provider Active NPI Adult Health Nurse Practitioner · Raleigh, NC
NPI 1295721710 · NPPES record last updated Jun 30, 2010
Key facts
- NPI
- 1295721710
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 900106 (NC)
- Practice address
- 10 Sunnybrook Rd
Clinic a
Raleigh, NC 27610-1808 - Phone
- (919) 250-3078
- Fax
- (919) 250-4429
- NPI assigned
- Sep 20, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advance Community Health Inc
Practice addresses (Care Compare)
1001 Rock Quarry Rd
Raleigh, NC 27610-3825
1011 Rock Quarry Rd
Raleigh, NC 27610-3825
Phone (919) 833-3111
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- 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 |
|---|---|---|---|---|
| I20100329000745 | NC | Practitioner - Nurse Practitioner | 2264568310 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Doctor of Philosophy, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 900106 | NC | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advance Community Health, Inc | Current |
Accepting new patients | |
| County of Wake | Current | Accepting new patients | |
| Whitman-Walker Clinic Inc. | Past | Accepting new patients | |
| Advance Community Health, Inc | Past | Accepting new patients |
Locations
205 Sandalwood Ave
Louisburg, NC 27549
Phone (919) 496-4250
1011 Rock Quarry Rd
Raleigh, NC 27610
1430 S Wilmington St
Raleigh, NC 27603
2620 New Bern Ave
Raleigh, NC 27610
Phone (919) 255-6721
1011 Rock Quarry Rd
Fl 2
Raleigh, NC 27610
Interoperability endpoints
- rdodge79593@direct.unc.nchie.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 900106 | NC | Yes |
Addresses
Primary practice location
10 Sunnybrook Rd
Clinic a
Raleigh, NC 27610-1808
Mailing address
10 Sunnybrook Rd
Clinic a
Raleigh, NC 27610-1808
Phone (919) 250-3078
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7000428 | Medicaid | NC |
Other providers in Raleigh, NC
- Larissa D Dodd
- Lawrence Dodd
- Michael James Doden
- Kayla Dodge
- Mary Dodge
- Gwen Dodson
- Michelle Dodson
- Sara Dodson
- Timothy Dodson
- Sydney Doe
All providers in Raleigh, NC · Adult Health Nurse Practitioner in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2010. 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.