NPIMap

Individual provider Active NPI

Jerome Ivan Dickman, M.D.

  • Otolaryngology Physician
  • Bell Canyon, CA
National Provider Identifier
1174581227
Registry record updated Oct 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A21070 Issued in CA
Practice address
33 Saddlebow Rd
Bell Canyon, CA 91307-1137
Phone
(818) 884-5121
Fax
(818) 999-0275
NPI assigned
May 1, 2006
Last updated
Oct 31, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X A21070 CA Primary

Addresses

Primary practice location

33 Saddlebow Rd
Bell Canyon, CA 91307-1137

Mailing address

33 Saddlebow Rd
Bell Canyon, CA 91307-1137
Phone (818) 884-5121

Other identifiers 1

IdentifierTypeStateIssuer
00A210700MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

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. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21070CAMDPsychologist
A21070CAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Hills Hospital Past Accepting new patients
Dignity Community Care Past Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Providence Facey Medical Foundation Otolaryngology Past Accepting new patients
Henry Mayo Newhall Memorial Hospital Past Accepting new patients
Providence Facey Medical Foundation Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477872000000",
    "number": "1174581227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 SADDLEBOW RD",
            "city": "BELL CANYON",
            "state": "CA",
            "postal_code": "913071137",
            "telephone_number": "818-884-5121",
            "fax_number": "818-999-0275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 SADDLEBOW RD",
            "city": "BELL CANYON",
            "state": "CA",
            "postal_code": "913071137",
            "telephone_number": "818-884-5121",
            "fax_number": "818-999-0275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKMAN",
        "first_name": "JEROME",
        "middle_name": "IVAN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2016-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A21070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A210700",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bell Canyon, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.