Active NPI
Polly Chrysanthemum Dodds
- Family Nurse Practitioner
- Copperopolis, CA
National Provider Identifier
1821622820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- NP95013962
- 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
- 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 | 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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 Center
Practice addresses (Care Compare)
590 Stanislaus Ave
Angels Camp, CA 95222-9355
Phone (209) 736-0813
Hospital & facility affiliations
- Mark Twain Medical Center
- Adventist Health Sonora
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP95013962 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark Twain Medical Center | Current | 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 5
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.
-
- Rural Health Clinic/Center
- San Andreas, CA
- NPI 1205002938
-
- Rural Health Clinic/Center
- Copperopolis, CA
- NPI 1588725196
-
- Rural Health Clinic/Center
- Arnold, CA
- NPI 1790846301
-
- Rural Health Clinic/Center
- Angels Camp, CA
- NPI 1942362561
Hospital & facility affiliations 13
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.