NPIMap

Organization Active NPI

Dickson Orthopedics, P.a.

  • Orthopaedic Surgery Physician
  • Jonesboro, AR
National Provider Identifier
1063487809
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MC0874 Issued in AR
Legal business name
DICKSON ORTHOPEDICS, P.A.
Practice address
1010 S Main St
Jonesboro, AR 72401-3503
Phone
(870) 932-1820
Fax
(870) 972-6712
NPI assigned
Feb 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

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

Authorized official

Name
Kacey Lynn Davis
Title
Office Manager
Phone
(870) 932-1820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X MC0874 AR Primary

Addresses

Primary practice location

1010 S Main St
Jonesboro, AR 72401-3503

Mailing address

1010 S Main St
Jonesboro, AR 72401-3503
Phone (870) 932-1820

Other practice location 1

1416 E Matthews Ave Ste 200
Jonesboro, AR 72401-4362
Phone (870) 932-1820

Other identifiers 3

IdentifierTypeStateIssuer
CE8064OtherARRAILROAD MEDICARE
232042748MedicaidAR
129705002MedicaidAR

Other names 1

  • Jonesboro Orthopedics and Sports Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040827000619 AR Part B Supplier - Clinic/Group Practice 9335114941 Receives reassigned benefits from 19 practitioners
Practice locations: Jonesboro, AR
O20100930077280 AR DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9335114941 Practice locations: Jonesboro, AR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693526400000",
    "number": "1063487809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 S MAIN ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013503",
            "telephone_number": "870-932-1820",
            "fax_number": "870-972-6712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 S MAIN ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013503",
            "telephone_number": "870-932-1820",
            "fax_number": "870-972-6712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1416 E Matthews Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724014362",
            "country_code": "US",
            "telephone_number": "870-932-1820",
            "fax_number": "870-972-6712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DICKSON ORTHOPEDICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KACEY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "870-932-1820"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "AR",
            "license": "MC0874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CE8064",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232042748",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129705002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jonesboro Orthopedics and Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.