Kevin L Dickerson, C.R.N.A.

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

54468 Issued in WV

Practice address

2900 1St Ave
Huntington, WV 25702-1241

Phone

(304) 526-1031

NPI assigned

Nov 14, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WV, OH, IN3 enrollments

Enrollment records 3

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

River Cities Anesthesia PLLCGroup PAC ID 6002707015, 60 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Marys Medical Center Hospital, Huntington, WV, CCN 510007

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• River Cities Anesthesia PLLC

  • Anesthesiology Physician
  • Huntington, WV
  • NPI 1699845164

  Nurse Anesthetist, Certified Registered, OH

  Medicare reassignment Care Compare group NPD
• Northstar Anesthesia of Indiana LLC

  • Anesthesiology Physician
  • Arlington, TX
  • NPI 1043561541

  IN, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD

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

• St. Mary'S Medical Center Inc

  • General Acute Care Hospital
  • Huntington, WV
  • NPI 1164492195
  Care Compare affiliation

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316736000000",
    "number": "1083786180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 515",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255040515",
            "telephone_number": "304-736-6126",
            "fax_number": "304-736-1531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 1ST AVE",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257021241",
            "telephone_number": "304-526-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "KEVIN",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "C.R.N.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2011-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "54468",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "08320",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV BLUE CROSS PROVIDER #",
            "identifier": "001721151",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001843",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV WORKERS COMP",
            "identifier": "550696369-00",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Dial
• Cara Michelle Dials, APRN
• Pamela Gayle Dice, RN CFNP
• Joshua Caleb Dickens
• Kasandra L Dickerson
• Shayla Dickerson
• Deborah Dianne Dickson
• Scarlette Lea Dickson
• Tristan Gage Dickson
• Joshua Dierdorff, PTA

• Certified Registered Nurse Anesthetist in Huntington, WV
• Providers in Huntington, WV by specialty
• Certified Registered Nurse Anesthetist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.