Active NPI
Michael O Dodd, MS
- Psychologist
- El Dorado, AR
National Provider Identifier
1821066374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 91-17E
- Practice address
- 715 N College Ave
El Dorado, AR 71730-4403 - Phone
- (870) 862-7921
- NPI assigned
- Mar 10, 2006
- Last updated
- Aug 14, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 91-17E | AR | Primary |
Addresses
Primary practice location
715 N College Ave
El Dorado, AR 71730-4403
Mailing address
715 N College Ave
El Dorado, AR 71730-4403
Phone (870) 862-7921
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5T974 | Other | AR | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 91-17E | AR | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218672000000",
"number": "1821066374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "715 N COLLEGE AVE",
"city": "EL DORADO",
"state": "AR",
"postal_code": "717304403",
"telephone_number": "870-862-7921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 N COLLEGE AVE",
"city": "EL DORADO",
"state": "AR",
"postal_code": "717304403",
"telephone_number": "870-862-7921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODD",
"first_name": "MICHAEL",
"middle_name": "O",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-10",
"last_updated": "2008-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AR",
"license": "91-17E",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "5T974",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Dorado, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.