Nikole Renae Dodge, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9108578 Issued in FL

Practice address

379 6TH Ave W
Bradenton, FL 34205-8820

Phone

(941) 782-4100

Fax

(941) 782-4101

NPI assigned

Apr 17, 2015

Last updated

Jun 1, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

First Step of Sarasota IncGroup PAC ID 9830324169, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Lightshare Behavioral Wellness and Recovery

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Sarasota, FL
  • NPI 1578551198
  Medicare reassignment Care Compare group
• Centerstone of Florida, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sarasota, FL
  • NPI 1033789052
  NPD (past)
• Lightshare Behavioral Wellness and Recovery

  • Community/Behavioral Health Agency
  • Venice, FL
  • NPI 1710557830
  NPD (past)

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

{
    "created_epoch": "1429228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527811200000",
    "number": "1902293830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6804 CECELIA DR",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346534935",
            "telephone_number": "727-232-0644",
            "fax_number": "888-546-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "379 6TH AVE W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342058820",
            "telephone_number": "941-782-4100",
            "fax_number": "941-782-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODGE",
        "first_name": "NIKOLE",
        "middle_name": "RENAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-17",
        "last_updated": "2018-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Doctor to You (D2U Physical Therapy)
• Doctor's Choice Home Care, LLC (Aveanna Home Health)
• Doctors Medical Practice LLC
• Doctors of Manatee
• Jodie Lynn Dodge, ARNP-C
• Taylor Lloyd Dodgen
• Elizabeth Grace Doeller, ATC, EMT-B
• Elaine E Dohms, LMT
• Gary Neil Dolin, MD
• Tenzing Dolkar

• Physician Assistant in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; 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.