Kaisa Lyn Dodge, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

63525 Issued in CA

Practice address

18300 US Highway 18
Apple Valley, CA 92307-2206

Phone

(760) 242-2311

NPI assigned

Jul 18, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Cep America - California

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542

  CA

  Medicare reassignment
• Cep America - California

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843

  CA

  Medicare reassignment
• Cep America - California

  • Emergency Medicine Physician
  • Manteca, CA
  • NPI 1316693187
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Los Alamitos, CA
  • NPI 1497430870
  NPD

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

{
    "created_epoch": "1689638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1992485643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 E 2ND ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18300 US HIGHWAY 18",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072206",
            "telephone_number": "760-242-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODGE",
        "first_name": "KAISA",
        "middle_name": "LYN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-18",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "63525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Divya V Patel MD Inc
• Maggie DO
• James Han Doan, PHARMD
• Doctor Virginia Schwab
• Steven Jeffrey Dodds, MD
• Rebecca Ruth Dodge
• Emily Brianne Does, PA-C
• Melissa Doiron-Min, IMF
• Kaitlin Joy Dolinar, PHYSICIAN ASSISTANT
• Mliss M Doman, PSY.D.

• All providers in Apple Valley, CA
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.