Individual provider Active NPI

Jeffrey A Dodson, M.D.

  • Dermatology Physician
  • Bridgeport, WV
National Provider Identifier
1649212903
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
21906 Issued in WV
Practice address
120 Medical Park Dr
Suite 200
Bridgeport, WV 26330-9012
Phone
(304) 624-7200
Fax
(304) 624-0026
NPI assigned
Jun 12, 2006
Last updated
Jan 23, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 21906 WV Primary

Addresses

Primary practice location

120 Medical Park Dr
Suite 200
Bridgeport, WV 26330-9012

Mailing address

125 N 6TH St
Clarksburg, WV 26301-2665
Phone (304) 624-7200

Other identifiers 1

IdentifierTypeStateIssuer
3810004580MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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

Enrollment IDStateProvider typePAC IDDetails
I20050620000228 WV Practitioner - Dermatology 4284678327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
West Virginia University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain State Medical Specialties PLLCGroup PAC ID 9335046754, 38 clinicians

Practice addresses (Care Compare)

120 Medical Park Dr
Suite 200
Bridgeport, WV 26330-9013
Phone (304) 624-7200

Merit-based Incentive Payment System (MIPS)

Final score
90.43 of 100Reported as group
Quality
88.74
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision66
Removal of skin lesions1678
Removal or shaving of skin growth15
Skin biopsy360

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain State Medical Specialties, PLLC Dermatology CurrentSince Jul 1, 2005 Accepting new patients

Locations

120 Medical Park Dr
Ste 200
Bridgeport, WV 26330
Phone (304) 624-7200

125 N 6th St
Clarksburg, WV 26301
Phone (304) 623-6533

165 Scott Ave
Ste 100
Morgantown, WV 26508
Phone (304) 554-0400

Interoperability endpoints

  • Direct secure messaging: jdodson@msms.emadirect.md

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421971200000",
    "number": "1649212903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N 6TH ST",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263012665",
            "telephone_number": "304-624-7200",
            "fax_number": "304-624-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEDICAL PARK DR",
            "address_2": "SUITE 200",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309012",
            "telephone_number": "304-624-7200",
            "fax_number": "304-624-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODSON",
        "first_name": "JEFFREY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2015-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WV",
            "license": "21906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004580",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, WV

Sources for this page

Verify at the official NPI Registry.