James Wiley Dickerson III, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

1020407 Issued in MA

Practice address

1200 Hilyard St
Suite S-460
Eugene, OR 97401-8122

Phone

(541) 685-1794

NPI assigned

Sep 21, 2005

Sex

Male

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 WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wdickerson3057@direct.peacehealth.org

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.

• Alliance for South Sound Health

  • Psychiatric Hospital
  • Tacoma, WA
  • NPI 1891298980
  Medicare reassignment NPD
• Beaufort County Memorial Hospital

  • Emergency Medicine Physician
  • Beaufort, SC
  • NPI 1871335018
  NPD (past)

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1023004512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24410",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974020451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HILYARD ST",
            "address_2": "SUITE S-460",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974018122",
            "telephone_number": "541-685-1794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "JAMES",
        "middle_name": "WILEY",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD150778",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "1020407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willy Anthony Diaz Tapia
• Cameron Diaz-Johnson, PHD, LP
• Cristina Marie Diaz, SWI
• Kristine Elizabeth Dibos, OTR/L, OTD
• Nicholas Ryan Dibos
• Elizabeth Dickey
• Virgil Andrew Dickey Jr., N/A
• Zachary Dickison
• John Dickson
• Robert Didericksen, PMHNP-BC

• Psychiatry Physician in Eugene, OR
• Providers in Eugene, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; 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.