NPIMap

Organization Active NPI

Dickson Medical Associates, PC

  • Rural Health Clinic/Center
  • Dickson, TN
National Provider Identifier
1003425224
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DICKSON MEDICAL ASSOCIATES, PC
Practice address
127 Crestview Park Dr Ste 205
Dickson, TN 37055-2856
Phone
(615) 446-5121
Fax
(615) 446-1357
NPI assigned
Jul 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Authorized official

Name
Christie Strong
Title
Executive Director
Phone
(615) 446-1324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

127 Crestview Park Dr Ste 205
Dickson, TN 37055-2856

Mailing address

127 Crestview Park Dr Ste 209
Dickson, TN 37055-2856
Phone (615) 446-5121

Other identifiers 1

IdentifierTypeStateIssuer
3721355MedicaidTN

Other names 1

  • DMA Crestview Pediatrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210218001405 TN Part A Provider - Rural Health Clinic 3971408774 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dickson, TN

Rural health clinic certification: CCN 883843

Legal name
DICKSON MEDICAL ASSOCIATES, PC
Doing business as
DMA SOUTH PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 24, 2021
Last certification
May 24, 2021
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jan 1, 2001 in TN
Enrollment address
768 Highway 46 S
Dickson, TN 37055-2556

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kerry W Ross Individual 5% Or Greater Direct Ownership Interest Jul 26, 2004 4.93%
Corporate OfficerVice President Sep 29, 2025
Jeffrey Alan Culp Individual 5% Or Greater Direct Ownership Interest Nov 6, 2023 4.93%
Demond C White Individual 5% Or Greater Direct Ownership Interest Apr 1, 2014 4.93%
Matthew L Sarb Individual 5% Or Greater Direct Ownership Interest Apr 1, 2022 4.93%
Patrick M Luchini Individual 5% Or Greater Direct Ownership Interest Dec 30, 2025 4.93%
Deline Kirubanathan Individual 5% Or Greater Direct Ownership Interest Apr 1, 2022 4.93%
Caroline Farrar Individual 5% Or Greater Direct Ownership Interest Jun 24, 2025 4.93%
Daniel J Sherwood Individual 5% Or Greater Direct Ownership Interest Nov 1, 2020 4.93%
Mary K McNeal Individual 5% Or Greater Direct Ownership Interest Sep 1, 2004 4.93%
Corporate OfficerPresident Sep 29, 2025 100%
Dolores J Lucas Individual Other Jan 24, 2021 2.4%
David J Blazer Individual 5% Or Greater Direct Ownership Interest Jan 1, 2001 4.43%
Enawgaw B Mehari Individual 5% Or Greater Direct Ownership Interest May 1, 2023 4.93%
Vera H Huffnagle Individual 5% Or Greater Direct Ownership Interest Jan 1, 2001 4.93%
Ehab S Kasasbeh Individual 5% Or Greater Direct Ownership Interest Apr 1, 2014 4.93%
John Bradford McDonough Individual 5% Or Greater Direct Ownership Interest Jul 9, 2025 4.93%
Christie Strong Individual Operational/Managerial ControlExecutive Director May 12, 2018 100%
William Brewer Individual 5% Or Greater Direct Ownership Interest Mar 31, 2021 4.93%
Corporate OfficerTreasurer Jan 1, 2025
Abigail L Ryan Individual 5% Or Greater Direct Ownership Interest Nov 6, 2023 4.93%
David L Ross Individual 5% Or Greater Direct Ownership Interest Aug 1, 2004 4.93%
Robert W Orgain Individual 5% Or Greater Direct Ownership Interest May 29, 1987 4.43%
Mohammad a Alsoub Individual 5% Or Greater Direct Ownership Interest Apr 1, 2022 4.93%
Howard M Hammer Individual 5% Or Greater Direct Ownership Interest Feb 15, 2024 4.93%
Corporate OfficerSecretary Jan 1, 2025

Owners & managing parties with NPI records 21

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 21

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625702400000",
    "number": "1003425224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 CRESTVIEW PARK DR STE 209",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552856",
            "telephone_number": "615-446-5121",
            "fax_number": "615-446-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 CRESTVIEW PARK DR STE 205",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552856",
            "telephone_number": "615-446-5121",
            "fax_number": "615-446-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKSON MEDICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-23",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A",
        "authorized_official_last_name": "STRONG",
        "authorized_official_first_name": "CHRISTIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "615-446-1324"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3721355",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DMA Crestview Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dickson, TN

Sources for this page

Verify at the official NPI Registry.