Jeremy Christian Dickinson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

8351 Azimuth Dr
Baldwinsville, NY 13027-6206

Phone

(315) 415-9613

NPI assigned

Aug 3, 2023

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 NY

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1073295564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 PORTLAND AVE STE 309",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213008",
            "telephone_number": "585-342-2638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8351 AZIMUTH DR",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130276206",
            "telephone_number": "315-415-9613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKINSON",
        "first_name": "JEREMY",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-03",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen A Demick, PHARMD.
• Jacqueline Cristine Depaulis Fiumano, N.P.
• Jaclyn Rita Derito, LMSW
• Jennifer Deshaies, IBCLC
• Kathy Ann Devine
• Nikeysha Marie Dickinson, L.P.N.
• Stephanie A Dillard, LCSW
• Deven Michelle Dinet, LPN
• Marjorie Irene Dirisio Duger, REGISTERED NURSE
• Samantha E. Dise, RPH

• Physician Assistant in Baldwinsville, NY
• Providers in Baldwinsville, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.