NPIMap

Individual provider Active NPI

Polly Chrysanthemum Dodds

  • Family Nurse Practitioner
  • Copperopolis, CA
National Provider Identifier
1821622820
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP95013962 Issued in CA
Practice address
430 Sawmill Creek Rd Unit 6
Copperopolis, CA 95228-9242
Phone
(209) 785-7000
Fax
(209) 785-7025
NPI assigned
Feb 27, 2020
Last updated
Dec 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP95013962 CA Primary

Addresses

Primary practice location

430 Sawmill Creek Rd Unit 6
Copperopolis, CA 95228-9242

Mailing address

430 Sawmill Creek Rd Unit 6
Copperopolis, CA 95228-9242
Phone (209) 785-7000

Other names 1

  • Polly Chrysanthemum Beukers Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200702001992 CA Practitioner - Nurse Practitioner 5991128753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mark Twain Medical CenterGroup PAC ID 8820073711, 27 clinicians

Practice addresses (Care Compare)

590 Stanislaus Ave
Angels Camp, CA 95222-9355
Phone (209) 736-0813

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP95013962CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center CurrentSince Jun 6, 2021 Accepting new patients

Locations

430 Sawmill Creek Rd
Unit 6
Copperopolis, CA 95228
Phone (209) 785-7000

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1821622820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 SAWMILL CREEK RD UNIT 6",
            "city": "COPPEROPOLIS",
            "state": "CA",
            "postal_code": "952289242",
            "telephone_number": "209-785-7000",
            "fax_number": "209-785-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 SAWMILL CREEK RD UNIT 6",
            "city": "COPPEROPOLIS",
            "state": "CA",
            "postal_code": "952289242",
            "telephone_number": "209-785-7000",
            "fax_number": "209-785-7025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODDS",
        "first_name": "POLLY",
        "middle_name": "CHRYSANTHEMUM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-27",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95013962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "POLLY",
            "last_name": "BEUKERS",
            "middle_name": "CHRYSANTHEMUM",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Copperopolis, CA

Sources for this page

Verify at the official NPI Registry.