NPIMap

Organization Active NPI

Dickinson County Healthcare System

Doing business as Dickinson Telemedicine

  • Pediatric Neurodevelopmental Disabilities Physician
  • Iron Mountain, MI
National Provider Identifier
1154613594
Registry record updated May 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X
Legal business name
DICKINSON COUNTY HEALTHCARE SYSTEM
Doing business as
Dickinson Telemedicine
Practice address
1711 S Stephenson Ave
Suite 230
Iron Mountain, MI 49801-3639
Phone
(906) 774-1313
Fax
(906) 776-5639
NPI assigned
May 4, 2011
Last updated
May 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2011

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

Authorized official

Name
Alicia Henderson, CPC, CCP
Title
Physician Billing Supervisor
Phone
(906) 776-5665

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MI
Pediatric Neurodevelopmental Disabilities Physician 2080P0008X MI Primary
Neurology Physician 2084N0400X MI
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X MI

Addresses

Primary practice location

1711 S Stephenson Ave
Suite 230
Iron Mountain, MI 49801-3639

Mailing address

PO Box 549
Iron Mountain, MI 49801-0549
Phone (906) 774-1313

Other names 1

  • Dickinson Telemedicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000583 MI Part B Supplier - Clinic/Group Practice 6800784943 Receives reassigned benefits from 156 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Skandia, MI; Novi, MI; Munising, MI; Marquette, MI; Kingsford, MI; Ishpeming, MI; Iron River, MI; Iron Mountain, MI…
O20050623000153 MI Part B Supplier - Clinic/Group Practice 6800784943 Receives reassigned benefits from 13 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Iron Mountain, MI; Norway, MI; Marquette, MI; Kingsford, MI; Ishpeming, MI; Iron River, MI; Bark River, MI

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1154613594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498010549",
            "telephone_number": "906-774-1313",
            "fax_number": "906-776-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 S STEPHENSON AVE",
            "address_2": "SUITE 230",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498013639",
            "telephone_number": "906-774-1313",
            "fax_number": "906-776-5639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKINSON COUNTY HEALTHCARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "PHYSICIAN BILLING SUPERVISOR",
        "authorized_official_telephone_number": "906-776-5665",
        "authorized_official_credential": "CPC, CCP"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dickinson Telemedicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Iron Mountain, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.