Fred David Dodge, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-40095 Issued in ID

Practice address

2650 S Eagle Rd
Meridian, ID 83642-6725

Phone

(986) 200-4290

NPI assigned

May 4, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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 Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mental Health Specialty Group PAGroup PAC ID 8921466228, 726 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  ID

  Medicare reassignment Care Compare group NPD
• Idaho TMS

  • Psychiatric/Mental Health Nurse Practitioner
  • Boise, ID
  • NPI 1841857513
  Medicare reassignment NPD

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

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789948800000",
    "number": "1669117438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 VIA VALDARNO",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015830",
            "telephone_number": "512-630-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 S EAGLE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426725",
            "telephone_number": "986-200-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODGE",
        "first_name": "FRED",
        "middle_name": "DAVID",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-04",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-40095",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "8851160-3501",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Doan, DPT
• Phu M Doan, PHARMD
• Doctor's Hospice of Idaho LLC
• Doctors House Calls, LLC (Doctors House Calls)
• Carson Dodd, DPT
• Sarah N Dodge, PT
• Chaunce Dolan, RN
• Natalie A Domangue-Shiflett, MD
• Hillary Donahue, PA-C
• Cailene Jean Donaldson, RMHCI

• Clinical Social Worker in Meridian, ID
• Providers in Meridian, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; 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.