Keith Dickerson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

42576 Issued in CO

Practice address

1160 Patterson Rd
Grand Junction, CO 81506-8275

Phone

(970) 298-2800

Fax

(970) 298-7522

NPI assigned

Dec 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Family Practice

Education

Medical College of Pennsylvania, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Marys Hospital and Medical Center IncGroup PAC ID 1557267069, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health St. Mary's Regional Hospital Hospital, Grand Junction, CO, CCN 060023

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdickerson9142@direct.intermountainhealth.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.

• St Mary's Hospital and Medical Center, Inc

  • Hematology & Oncology Physician
  • Grand Junction, CO
  • NPI 1275714081

  Family Medicine

  Medicare reassignment Care Compare group NPD
• St Mary's Hospital and Medical Center, Inc

  dba St Mary's Anticoagulation Clinic

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1619742806
  NPD
• St. Mary's Hospital and Medical Center, Inc.

  dba Intermountain Health St Mary's Regional Hospital

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1699716027
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Mary's Hospital and Medical Center, Inc

  dba St Mary's CareFlight

  • Ambulance
  • Grand Junction, CO
  • NPI 1164060877

  Hospital

  Care Compare affiliation
• St Mary's Hospital and Medical Center, Inc

  dba St Mary's Anticoagulation Clinic

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1619742806
  Care Compare affiliation
• St Mary's Hospital and Medical Center, Inc

  dba St Mary's Hospital & Medical Center Life Center OT/PT/SP

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1821647801
  Care Compare affiliation
• St. Mary's Hospital and Medical Center, Inc.

  dba Intermountain Health St Mary's Regional Hospital

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1699716027
  Care Compare affiliation

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301875200000",
    "number": "1043296924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 PATTERSON RD",
            "address_2": "PO BOX 62",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815068275",
            "telephone_number": "970-298-2800",
            "fax_number": "970-298-7522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 PATTERSON RD",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815068275",
            "telephone_number": "970-298-2800",
            "fax_number": "970-298-7522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "KEITH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2011-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "42576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01470825",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eleanor Diamse, NP
• Connor Diaz
• Derek Dennis Diaz, PA-C
• Paula Yolanda Diaz
• Bailey Dicamillo
• Amber Nichole Dickey, LMT
• Deborah Ann Didonato, RN
• Brittany Danielle Diehl, MS
• David Homer Dietel, MD
• Megan Dighero, PA-C

• Family Medicine Physician in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; 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.