Sean Dodge, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2871 Issued in OR

Practice address

211 NW Larch Ave
Redmond, OR 97756-1357

Phone

(541) 548-2164

Fax

(541) 548-0534

NPI assigned

Sep 3, 2008

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NV, OR2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Charles Health System IncGroup PAC ID 3870402852, 174 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• St. Charles Health System, Inc.

  • General Acute Care Hospital
  • Bend, OR
  • NPI 1982621447
  Medicare reassignment Care Compare group NPD
• State of Nevada

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ely, NV
  • NPI 1760572010
  Medicare reassignment NPD
• Blue Skies Psychological Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Reno, NV
  • NPI 1720560832
  NPD Authorized official
• St. Charles Health System, Inc.

  • Rehabilitation Hospital Unit
  • Bend, OR
  • NPI 1154343150
  NPD
• St. Charles Health System, Inc.

  • Rural Health Clinic/Center
  • Prineville, OR
  • NPI 1407178528
  NPD
• State of Nevada

  • Skilled Nursing Facility
  • Boulder City, NV
  • NPI 1083612741
  NPD
• State of Nevada

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gardnerville, NV
  • NPI 1972684355
  NPD
• St. Charles Health System, Inc.

  • Home Health Agency
  • Madras, OR
  • NPI 1225226004
  NPD (past)
• St. Charles Health System, Inc.

  • Critical Access Hospital
  • Prineville, OR
  • NPI 1710160445
  NPD (past)
• St. Charles Health System, Inc.

  • Clinical Social Worker
  • Bend, OR
  • NPI 1780698696
  NPD (past)

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1922256809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 NE 3RD ST STE 1061019",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013894",
            "telephone_number": "775-297-8855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 NW LARCH AVE",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977561357",
            "telephone_number": "541-548-2164",
            "fax_number": "541-548-0534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1665 Old Hot Springs Rd",
            "address_2": "Suite 157",
            "address_purpose": "LOCATION",
            "city": "Carson City",
            "state": "NV",
            "postal_code": "897060782",
            "country_code": "US",
            "telephone_number": "775-687-4195 x275",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3495 Lakeside Dr # 1093",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895094841",
            "country_code": "US",
            "telephone_number": "775-297-8855",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1617 SW Overturf Ave",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977021001",
            "country_code": "US",
            "telephone_number": "503-753-7192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DODGE",
        "first_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2024-04-02",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NV",
            "license": "PY0624",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sdodge192188@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "211 NW Larch Ave",
            "city": "Redmond",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977561357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Derek Devol
• Anthony Dicenzo, LMFT
• Discover Chiropractic Redmond
• Lester Jonathan Dixon, MD
• Steven Dobson
• Ashton Elizabeth Dodson-Lupton, RN
• Nadine Marianne Dody, MA MFT LPC
• Danielle Lancelot Doelling, OTR/L
• Lania Dolan, RPH
• Stephanie Iwalani Dolan, PNP

• Clinical Psychologist in Redmond, OR
• Providers in Redmond, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; 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.