Active NPI
Katherine J Dodson, FNP
- Family Nurse Practitioner
- Portland, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 200850015NP
- Practice address
- 1040 NW 22ND Ave
Suite 420
Portland, OR 97210-3057 - Phone
- (503) 963-3100
- Fax
- (503) 459-5398
- NPI assigned
- Mar 24, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 200850015NP | OR | Primary |
Addresses
Primary practice location
1040 NW 22ND Ave
Suite 420
Portland, OR 97210-3057
Mailing address
847 NE 19TH Ave
Suite 300
Portland, OR 97232-2684
Phone (503) 963-2801
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 242538 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1040 NW 22ND Ave
Portland, OR 97210-3062
1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988
Hospital & facility affiliations
- Amedisys Home Health Care
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.62 of 100
- Quality
- 77.21
- Promoting interoperability
- 99.06
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Clinics LLC | Current | Accepting new patients | |
| Legacy Clinics LLC | Current | Accepting new patients | |
| County of Clackamas Office of County Auditor | Past | Accepting new patients |
Locations
15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000
1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134
1040 NW 22nd Ave
Ste 420
Portland, OR 97210
Phone (503) 229-7566
Interoperability endpoints
- kdodson17562@direct.lhs.org
Organizations & group practices 3
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.
-
- Clinic/Center
- Portland, OR
- NPI 1902827272
-
- Rural Health Clinic/Center
- Sandy, OR
- NPI 1730472192
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Milwaukie, OR
- NPI 1245269315
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Portland, OR
- NPI 1134311988
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414108800000",
"number": "1629240239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "847 NE 19TH AVE",
"address_2": "SUITE 300",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322684",
"telephone_number": "503-963-2801",
"fax_number": "503-963-2825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 NW 22ND AVE",
"address_2": "SUITE 420",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972103057",
"telephone_number": "503-963-3100",
"fax_number": "503-459-5398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODSON",
"first_name": "KATHERINE",
"middle_name": "J",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-24",
"last_updated": "2014-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OR",
"license": "200850015NP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "242538",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; 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.