NPIMap

Individual provider Active NPI

Matthew R Dicker, MD

  • Specialist
  • Prescott, AZ
National Provider Identifier
1164418158
Registry record updated Jul 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
33711 Issued in AZ
Practice address
1000 Ainsworth Dr
Suite 115
Prescott, AZ 86305-1667
Phone
(928) 778-1971
Fax
(928) 443-8473
NPI assigned
Sep 23, 2005
Last updated
Jul 25, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 33711 AZ Primary

Addresses

Primary practice location

1000 Ainsworth Dr
Suite 115
Prescott, AZ 86305-1667

Mailing address

1000 Ainsworth Dr
Suite 115
Prescott, AZ 86305-1667
Phone (928) 778-1971

Other identifiers 1

IdentifierTypeStateIssuer
945040MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20050831000288 AZ Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 3274565189 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
Saint Louis University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prescott Radiologists LLPGroup PAC ID 4082699947, 12 clinicians

Practice addresses (Care Compare)

1003 Willow Creek Rd
Prescott, AZ 86301-1641
Phone (928) 445-2700

7700 E Florentine Rd
Prescott Valley, AZ 86314-2245
Phone (928) 445-2700

810 Whipple St
Prescott, AZ 86301-1606
Phone (928) 634-0665

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sonoran Radiology LTD CurrentSince Mar 1, 2024 Accepting new patients
Yrmc Hospice CurrentSince Mar 24, 2014 Accepting new patients
Prescott Radiologists LLP Specialist CurrentSince Aug 15, 2005 Accepting new patients
Yavapai Pathology Associates PLC Current Accepting new patients
Yavapai Community Hospital Association CurrentSince Mar 24, 2014 Accepting new patients
Associated Valley Radiologists LTD CurrentSince Mar 1, 2024 Accepting new patients

Locations

1000 Ainsworth Dr
Ste 115
Prescott, AZ 86305
Phone (928) 778-1971

1000 Ainsworth Dr
Ste 215
Prescott, AZ 86305

1003 Willow Creek Rd
Prescott, AZ 86301
Phone (928) 445-2700

810 Whipple St
Prescott, AZ 86301
Phone (928) 771-7577

7700 E Florentine Rd
Prescott Vly, AZ 86314
Phone (928) 445-2700

Organizations & group practices 6

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311552000000",
    "number": "1164418158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 AINSWORTH DR",
            "address_2": "SUITE 115",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051667",
            "telephone_number": "928-778-1971",
            "fax_number": "928-443-8473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 AINSWORTH DR",
            "address_2": "SUITE 115",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051667",
            "telephone_number": "928-778-1971",
            "fax_number": "928-443-8473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKER",
        "first_name": "MATTHEW",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2011-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "33711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "945040",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.