NPIMap

Individual provider Active NPI

Pandora M Hodge, PA

  • Medical Physician Assistant
  • Arden, NC
National Provider Identifier
1962642868
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
018625 Issued in GA
Practice address
436 Airport Road
Suite 20
Arden, NC 28704
Phone
(407) 200-2352
Fax
(407) 200-1360
NPI assigned
Mar 5, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5362 GA
Physician Assistant 363A00000X 0010-06056 NC
Medical Physician Assistant 363AM0700X 018625 GA Primary

Addresses

Primary practice location

436 Airport Road
Suite 20
Arden, NC 28704

Mailing address

PO Box 1869
Fletcher, NC 28732-1869
Phone (828) 687-5616

Other practice location 1

400 Charter Blvd
Macon, GA 31210-4831
Phone (478) 757-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090715000249 GA Practitioner - Physician Assistant 6305998857 Reassigns benefits to 4 organizations
I20170310000442 NY Practitioner - Physician Assistant 6305998857 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Canton-Potsdam HospitalGroup PAC ID 6204827280, 243 clinicians

Practice addresses (Care Compare)

201 Market St
Suite E
Potsdam, NY 13676-1218
Phone (315) 274-9102

50 Leroy St
Potsdam, NY 13676-1786
Phone (315) 265-3300

Hospital & facility affiliations

  • Canton-Potsdam Hospital Hospital, Potsdam, NY, CCN 330197
  • Gouverneur Hospital Hospital, Gouverneur, NY, CCN 331315
  • SLHS Massena, Inc Hospital, Massena, NY, CCN 331322

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
018625NYMDSpeech-Language Pathologist
0010-06056NCMDPhysician Assistant
018625GAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Unity Hospital of Rochester CurrentSince Feb 13, 2022 Accepting new patients
Canton-Potsdam Hospital CurrentSince Nov 29, 2024 Accepting new patients

Locations

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

Interoperability endpoints

  • Direct secure messaging: phodge338757@bassett.direct-ci.net
  • Direct secure messaging: phodge788290@direct.trinity-health.org

Organizations & group practices 11

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.

Hospital & facility affiliations 3

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": "1236211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1962642868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1869",
            "city": "FLETCHER",
            "state": "NC",
            "postal_code": "287321869",
            "telephone_number": "828-687-5616",
            "fax_number": "828-650-8076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 AIRPORT ROAD",
            "address_2": "SUITE 20",
            "city": "ARDEN",
            "state": "NC",
            "postal_code": "28704",
            "telephone_number": "407-200-2352",
            "fax_number": "407-200-1360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Charter Blvd",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312104831",
            "country_code": "US",
            "telephone_number": "478-757-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HODGE",
        "first_name": "PANDORA",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-05",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "5362",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06056",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "018625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arden, NC

Sources for this page

Verify at the official NPI Registry.