Individual provider Active NPI

Jaren Lance Dickey, MD

  • Emergency Medicine Physician
  • Tyler, TX
National Provider Identifier
1144724725
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
S3510 Issued in TX
Practice address
800 E Dawson St
Tyler, TX 75701-2036
Phone
(903) 593-8441
NPI assigned
Mar 20, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X S3510 TX Primary

Addresses

Primary practice location

800 E Dawson St
Tyler, TX 75701-2036

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-8800

Other practice location 1

1901 SW H K Dodgen Loop
Temple, TX 76502-1814
Phone (254) 724-5437

Other identifiers 2

IdentifierTypeStateIssuer
1P1619OtherTXMEDICARE
1P1799OtherTXMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, ID2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200110000830 TX Practitioner - Emergency Medicine 8224385539 Reassigns benefits to 5 organizations
I20220825000637 ID Practitioner - Emergency Medicine 8224385539 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Saint Louis University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3100 Channing Way
Idaho Falls, ID 83404-7533
Phone (208) 529-6111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
S3510TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Canyon Medical Center, Inc. CurrentSince Dec 15, 2023 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Jul 1, 2021 Accepting new patients
North Canyon Medical Center Inc. Current Accepting new patients
Concord Medical Group of Texas PLLC Emergency Medicine CurrentSince Nov 10, 2019 Accepting new patients
North Canyon Medical Center, Inc. CurrentSince Dec 15, 2023 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Jul 1, 2021 Accepting new patients
Mountain View Hospital LLC CurrentSince Jan 3, 2023 Accepting new patients
Christus Trinity Clinic Texas Current Accepting new patients
Century Integrated Partners, Inc Emergency Medicine CurrentSince Jun 1, 2020 Accepting new patients
Emergency Physicians Integrated Care, LLC Emergency Medicine CurrentSince May 13, 2022 Accepting new patients
Concord Medical Group PLLC Emergency Medicine CurrentSince Nov 10, 2019 Accepting new patients

Locations

267 N Canyon Dr
Gooding, ID 83330
Phone (208) 934-4433

3100 Channing Way
Idaho Falls, ID 83404
Phone (208) 227-2100

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

2327 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-1000

200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241

3500 Gaston Ave
Dallas, TX 75246

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

310 W South St
Henrietta, TX 76365
Phone (806) 647-2191

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

701 McClintic Dr
Lake Limestone, TX 76642
Phone (254) 729-3281

4700 Alliance Blvd
#P
Plano, TX 75093
Phone (469) 814-2000

2401 S 31st St
#11
Temple, TX 76508
Phone (254) 724-2518

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

1901 SW H K Dodgen Loop
Temple, TX 76502
Phone (254) 742-9256

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

Organizations & group practices 11

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.

Hospital & facility affiliations 3

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": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1144724725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E DAWSON ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012036",
            "telephone_number": "903-593-8441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 SW H K Dodgen Loop",
            "address_purpose": "LOCATION",
            "city": "Temple",
            "state": "TX",
            "postal_code": "765021814",
            "country_code": "US",
            "telephone_number": "254-724-5437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKEY",
        "first_name": "JAREN",
        "middle_name": "LANCE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-20",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "S3510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1P1619",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1P1799",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.