Active NPI
Michael Dickerson, M.D.
- Psychiatry Physician
- Sacramento, CA
National Provider Identifier
1174782288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 107976
- Practice address
- 2108 N St # 8975
Sacramento, CA 95816-5712 - Phone
- (415) 251-5830
- Fax
- (415) 276-5758
- NPI assigned
- Jun 3, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 107976 | CA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
2108 N St # 8975
Sacramento, CA 95816-5712
Mailing address
2108 N St # 8975
Sacramento, CA 95816-5712
Phone (415) 251-5830
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107976 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736899200000",
"number": "1174782288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2108 N ST # 8975",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958165712",
"telephone_number": "415-251-5830",
"fax_number": "415-276-5758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2108 N ST # 8975",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958165712",
"telephone_number": "415-251-5830",
"fax_number": "415-276-5758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-03",
"last_updated": "2025-01-15",
"certification_date": "2025-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "107976",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.