Takara Dickson, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA60134 Issued in CA

Practice address

1860 Pennsylvania Ave Ca
Ste 110
Fairfield, CA 94533-3550

Phone

(707) 646-4414

NPI assigned

Jun 15, 2020

Last updated

Jan 25, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Takara Ragland Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Utah School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northbay Physicians Surgery Center, LLCGroup PAC ID 0042122244, 336 clinicians

Northbay Health Medical FoundationGroup PAC ID 3274010871, 207 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northbay Medical Center Hospital, Fairfield, CA, CCN 050367

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Northbay Healthcare Group

  dba dba NorthBay Medical Center

  • General Acute Care Hospital
  • Fairfield, CA
  • NPI 1821147786
  Medicare reassignment Care Compare group NPD (past)
• Northbay Health Medical Foundation

  dba NorthBay Health Medical Network

  • Internal Medicine Physician
  • Fairfield, CA
  • NPI 1760283527
  Medicare reassignment Care Compare group
• Northbay Healthcare Group

  dba NorthBay VacaValley Hospital

  • Multi-Specialty Clinic/Center
  • Vacaville, CA
  • NPI 1760534713
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northbay Healthcare Group

  dba dba NorthBay Medical Center

  • General Acute Care Hospital
  • Fairfield, CA
  • NPI 1821147786
  Care Compare affiliation

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

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1184249146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PENNSYLVANIA AVE CA",
            "address_2": "STE 110",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333550",
            "telephone_number": "707-646-4414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 PENNSYLVANIA AVE CA",
            "address_2": "STE 110",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333550",
            "telephone_number": "707-646-4414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "375 S Chipeta Way",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841081260",
            "country_code": "US",
            "telephone_number": "801-585-0187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "TAKARA",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-15",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "60134",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA60134",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAKARA",
            "last_name": "RAGLAND",
            "credential": "PHYSICIAN ASSISTANT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Edgar Diaz
• Jocelyn Diaz
• Juliana Nataliah Diaz
• Xavier Rodrigo Diaz, COUNSELOR
• Nathan Ryan Dickerson
• Margaret Linda Difelice, PA C
• Sarah Humphrey Digeorge, NP
• Annabelle Dilem
• Christina Dimmick, MEDICAL ASSISTANT
• Shulan Ding, MD

• Medical Physician Assistant in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.