Timothy Dean Dodge, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2002011102 Issued in MO

Practice address

18975 W 115TH Ter
Olathe, KS 66061-6542

Phone

(913) 232-6861

NPI assigned

Jun 24, 2008

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 1

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Dodge Psychology Practice, LLC

  • Clinical Psychologist
  • Olathe, KS
  • NPI 1962701755
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346803200000",
    "number": "1598926362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18975 W 115TH TER",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660616542",
            "telephone_number": "913-232-6861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18975 W 115TH TER",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660616542",
            "telephone_number": "913-232-6861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODGE",
        "first_name": "TIMOTHY",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-24",
        "last_updated": "2012-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2002011102",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KS",
            "license": "1256",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "493776314",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alli Dippel
• Kimberly Dishman, WHNP
• Lisa L. Doane, M.D.
• Courtney Dodds
• Dodge Psychology Practice, LLC
• Theresa Doerfler, MA, LPC, NCC
• Kimberly Doerr, FNP-C
• Dennis Patrick Dolan, ATC
• Kristin Doll, AGNP-BC
• Dominick Scalise PHD LLC

• Psychologist in Olathe, KS
• Providers in Olathe, KS by specialty
• Psychologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; 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.