Jeremy Lee Dickerson, MD

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

P4860 Issued in TX

Practice address

1139 E Sonterra Blvd Ste 205
San Antonio, TX 78258-4349

Phone

(210) 874-3359

NPI assigned

Jun 2, 2009

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 TX

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

Sports Medicine

Education

Texas Tech University Health Science Center School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Methodist Physician Practices PLLCGroup PAC ID 8022171974, 176 clinicians

Shea Physical Therapy Specialists LLCGroup PAC ID 6204245194, 194 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Medical Center Hospital, San Antonio, TX, CCN 450058

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: 17674-dickerson-jeremy@direct.leadingreach.com
• Direct secure messaging: jeremy.dickerson@hca7.eclinicaldirectplus.com
• FHIR API: https://api.platform.athenahealth.com/16700/brand/2/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Methodist Physician Practices, PLLC

  • Surgery Physician
  • San Antonio, TX
  • NPI 1922252717

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Shea Physical Therapy Specialists LLC

  dba Shea Physical Therapy and Hand Therapy Services of Corpus Christi

  • Rehabilitation Clinic/Center
  • Corpus Christi, TX
  • NPI 1427634245
  Care Compare group

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

• VHS San Antonio Partners LLC

  dba Baptist Medical Center

  • General Acute Care Hospital
  • San Antonio, TX
  • NPI 1598744856
  Care Compare affiliation

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574812800000",
    "number": "1043446206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847824",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847824",
            "telephone_number": "903-877-7777",
            "fax_number": "903-877-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1139 E SONTERRA BLVD STE 205",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584349",
            "telephone_number": "210-874-3359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "414 Navarro St",
            "address_2": "Suite 1616",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782052516",
            "country_code": "US",
            "telephone_number": "210-224-2655",
            "fax_number": "866-644-0889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "JEREMY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-02",
        "last_updated": "2019-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "BP10035367",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TX",
            "license": "P4860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Dickens, OT
• Gabriela Dicker
• Alyssa Renee Dickerson
• Cassandra L Dickerson
• Jeffry Alan Dickerson, FNP
• Jill Theresa Dickerson, CNS-MS
• Rhonda Ellen Dickey, LVN
• Trevor Alexander Dickey, MD
• Samantha Morgan Dickie
• Amanda Taylor Dickinson, PHARMD

• Sports Medicine (Family Medicine) Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Sports Medicine (Family Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2019; 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.