Crystal Dawnelle Dickerson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

60959396 Issued in WA

Practice address

721 S Auburn St
Kennewick, WA 99336-5629

Phone

(509) 547-2204

NPI assigned

Jun 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Crystal Dawnelle Powell; Askew; Bonino Former name

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of New Mexico School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alpine Medical Group Colorado PLLCGroup PAC ID 1759743347, 101 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Alpine Medical Group Colorado PLLC

  • Family Medicine Physician
  • Denver, CO
  • NPI 1104501873
  Medicare reassignment Care Compare group NPD
• Colorado Health and Wellness PLLC

  • Family Medicine Physician
  • Greenwood Village, CO
  • NPI 1447124375
  Medicare reassignment NPD Authorized official
• Afterours Inc

  • Urgent Care Clinic/Center
  • Denver, CO
  • NPI 1871626747
  Medicare reassignment NPD
• Spire Health Pathways

  • Family Medicine Physician
  • Denver, CO
  • NPI 1972245595
  Medicare reassignment NPD
• Tri Cities Community Health

  • Federally Qualified Health Center (FQHC)
  • Pasco, WA
  • NPI 1659995504
  NPD (past)

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1184665697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911322",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802911322",
            "telephone_number": "888-269-7001",
            "fax_number": "303-764-6640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 S AUBURN ST",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993365629",
            "telephone_number": "509-547-2204"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Mercado St Ste 160",
            "address_purpose": "LOCATION",
            "city": "Durango",
            "state": "CO",
            "postal_code": "813017309",
            "country_code": "US",
            "telephone_number": "970-385-9850",
            "fax_number": "970-385-9854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "CRYSTAL",
        "middle_name": "DAWNELLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0035551",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "60959396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "73936006",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "POWELL; ASKEW; BONINO",
            "middle_name": "DAWNELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Avel M Diaz, BA
• Brandi Daneta Diaz, RN
• Danyell L Diaz, RDH
• Melinda Diaz
• Mia Dickenson
• Erin J Dickerson, RD
• Taliah Kathleen Dickinson, PTA
• Stephanie Eileen Didier
• Denise Janell Dietz, ED.D., MFT, NCC
• Maria Yesenia Diez Canseco

• Family Medicine Physician in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.