Michael M Dickerson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

200001115 Issued in NC

Practice address

800 Garfield Ave
Healing Center at CCMH
Parkersburg, WV 26101-5340

Phone

(304) 424-2228

Fax

(304) 420-7128

NPI assigned

Jul 20, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• DHHS IHS Phoenix Area

  • Clinic/Center
  • Peach Springs, AZ
  • NPI 1265719934

  TX

  Medicare reassignment NPD
• DHHS IHS Phoenix Area

  • Federal Public Health Clinic/Center
  • Havasu Lake, CA
  • NPI 1396022026

  TX

  Medicare reassignment NPD
• Irene Benn Medical Center

  • Clinic/Center
  • Moapa, NV
  • NPI 1841535317

  TX

  Medicare reassignment NPD
• Rosebud Indian Health Service

  • General Acute Care Hospital
  • Rosebud, SD
  • NPI 1194757369

  TX

  Medicare reassignment NPD
• Michael M. Dickerson, MD

  • Emergency Care Clinic/Center
  • Vienna, WV
  • NPI 1912148164
  NPD (past) Authorized official
• DHHS IHS Phoenix

  • Clinic/Center
  • Supai, AZ
  • NPI 1184901829
  NPD
• DHHS IHS Phoenix Area

  • Critical Access Hospital
  • Parker, AZ
  • NPI 1851678585
  NPD
• Rosebud Indian Health Service

  • Ambulatory Surgical Clinic/Center
  • Rosebud, SD
  • NPI 1790955128
  NPD
• Bestpractices of West Virginia, Inc.

  • Emergency Medicine Physician
  • Parkersburg, WV
  • NPI 1245284421
  NPD (past)
• Convenience Clinics of America, Inc

  • Urgent Care Clinic/Center
  • Parkersburg, WV
  • NPI 1235316027
  NPD (past)
• Bestpractices of North Carolina PC

  • Emergency Medicine Physician
  • Smithfield, NC
  • NPI 1770560591
  NPD (past)
• Marshall West Virginia Ed Associates, LLC

  • Emergency Medicine Physician
  • Lexington, KY
  • NPI 1831461755
  NPD (past)

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279584000000",
    "number": "1073512059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 GREENMONT HILLS DR",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261053292",
            "telephone_number": "304-424-2228",
            "fax_number": "304-420-7128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 GARFIELD AVE",
            "address_2": "HEALING CENTER AT CCMH",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261015340",
            "telephone_number": "304-424-2228",
            "fax_number": "304-420-7128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "MICHAEL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2010-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "200001115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89127TY",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST #",
            "identifier": "D0709",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC GROUP #015CK",
            "identifier": "127TY",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige Dew, DOT
• Thomas Dewey, LMT
• DHP of West Virginia Inc
• Leah Dickel, PRSS
• Gabrielle Nicole Dicken
• Rachelle Dickerson, R.PH.
• Tiffany Diddle
• Jessica Diehm
• Digestive Care Center, PLLC
• Rebecca Lynn Dillard

• Emergency Medicine Physician in Parkersburg, WV
• Providers in Parkersburg, WV by specialty
• Emergency Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; 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.