Active NPI
Thomas Richard Pickett, P.A.
- Physician Assistant
- Marion, OH
National Provider Identifier
1104919414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 50.002283
- Practice address
- 1050 Delaware Ave
Marion, OH 43302-6416 - Phone
- (740) 383-7770
- Fax
- (740) 383-7848
- NPI assigned
- Oct 2, 2006
- Last updated
- Oct 23, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50.002283 | OH | Primary |
Addresses
Primary practice location
1050 Delaware Ave
Marion, OH 43302-6416
Mailing address
# L-3652
Columbus, OH 43260-6453
Phone (740) 383-7927
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0071609 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50.002283 | OH | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Marion, OH
- NPI 1619230802
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445558400000",
"number": "1104919414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "# L-3652",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432606453",
"telephone_number": "740-383-7927",
"fax_number": "740-383-7942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 DELAWARE AVE",
"city": "MARION",
"state": "OH",
"postal_code": "433026416",
"telephone_number": "740-383-7770",
"fax_number": "740-383-7848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKETT",
"first_name": "THOMAS",
"middle_name": "RICHARD",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2015-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50.002283",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0071609",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marion, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; 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.