Patrick Russell Dodson, PAS
Individual provider Active NPI Physician Assistant · Jacksonville, FL
NPI 1437679685 · NPPES record last updated Sep 26, 2017
Key facts
- NPI
- 1437679685
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 9110653 (FL)
- Practice address
- 1 Shircliff Way
Jacksonville, FL 32204-4748 - Phone
- (904) 308-7300
- NPI assigned
- Jun 20, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- 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 |
|---|---|---|---|---|
| I20171031000981 | FL | Practitioner - Physician Assistant | 6002182490 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9110653 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America LLC | Current |
Accepting new patients | |
| Cep America LLC | Current |
Accepting new patients |
Locations
2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
1 Shircliff Way
Jacksonville, FL 32204
Phone (904) 332-0414
7800 US Highway 98 W
Miramar Beach, FL 32550
Phone (850) 267-1603
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9110653 | FL | Yes |
Addresses
Primary practice location
1 Shircliff Way
Jacksonville, FL 32204-4748
Mailing address
1419 Riva del Garda Way
None
Saint Augustine, FL 32092
Phone (904) 382-5575
Other providers in Jacksonville, FL
- Riley Sean Dodd
- Sarah Dodd
- Ajay Doddapaneni
- Angela Marie Dodson
- Brittany Paige Dodson
- Kyle Riley Doerger
- Charles Doerner
- Ashley Danielle Doerr
- Vahide M Dogan-Bag
- Aisha Lynette Doggette
All providers in Jacksonville, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2017. 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.