NPIMap

Individual provider Active NPI

Jim C Dickert, DO

  • Family Medicine Physician
  • Crystal River, FL
National Provider Identifier
1073695755
Registry record updated Jan 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS0005062 Issued in FL
Practice address
6199 W Gulf to Lake Hwy
Crystal River, FL 34429-2679
Phone
(352) 795-0644
Fax
(352) 795-5950
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS0005062 FL Primary

Addresses

Primary practice location

6199 W Gulf to Lake Hwy
Crystal River, FL 34429-2679

Mailing address

6199 W Gulf to Lake Hwy
Crystal River, FL 34429-2679
Phone (352) 795-0644

Other identifiers 1

IdentifierTypeStateIssuer
OS1276100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051115000118 FL Practitioner - Family PracticePractitioner - Internal Medicine 3577582170 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Meadowcrest Family Physicians PAGroup PAC ID 5597784199, 10 clinicians
Meadowcrest Physicians Partners LLCGroup PAC ID 7214233485, 6 clinicians

Practice addresses (Care Compare)

1250 N Vantage Point Dr
Crystal River, FL 34429-5736
Phone (352) 795-0644

6199 W Gulf to Lake Hwy
Crystal River, FL 34429-2679
Phone (352) 795-0644

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS0005062FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Meadowcrest Family Physicians, P.a. CurrentSince May 27, 2005 Accepting new patients
Meadowcrest Family Practice PA Family Medicine CurrentSince Oct 1, 1991 Accepting new patients
Meadowcrest Family Physicians, P.a. Family Medicine CurrentSince Jul 1, 2005 Accepting new patients
Meadowcrest Physicians Partners LLC Family Medicine CurrentSince Jan 19, 2016 Accepting new patients

Locations

1250 N Vantage Point Dr
Crystal River, FL 34429
Phone (352) 795-0644

5915 W Gulf To Lake Hwy
Crystal River, FL 34429
Phone (352) 794-3872

6199 W Gulf To Lake Hwy
Crystal River, FL 34429
Phone (352) 795-0644

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73059

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Meadowcrest Family Physicians PALecanto, FL, CCN 683851 Rural health clinic 5% Or Greater Indirect Ownership Interest (33.33%)
Operational/Managerial Control (33.33%)		 Feb 13, 2024
Feb 13, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296432000000",
    "number": "1073695755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6199 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344292679",
            "telephone_number": "352-795-0644",
            "fax_number": "352-795-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6199 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344292679",
            "telephone_number": "352-795-0644",
            "fax_number": "352-795-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERT",
        "first_name": "JIM",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2011-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS0005062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OS1276100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal River, FL

Sources for this page

Verify at the official NPI Registry.