Active NPI
Mark Thomas Dickinson, MD
- Urology Physician
- Franklin, TN
National Provider Identifier
1215914239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- MD37792
- Practice address
- 4601 Carothers Pkwy
Ste 475
Franklin, TN 37067-5980 - Phone
- (615) 790-1660
- Fax
- (615) 790-3705
- NPI assigned
- Dec 30, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | MD37792 | TN | Primary |
| Urology Physician | 208800000X | A67587 | CA |
Addresses
Primary practice location
4601 Carothers Pkwy
Ste 475
Franklin, TN 37067-5980
Mailing address
2801 Charlotte Ave
Nashville, TN 37209-4035
Phone (615) 250-9200
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3886483 | Medicaid | TN | |
| P00035782 | Other | TN | RR MEDICARE |
| 64069941 | Medicaid | KY | |
| 4067530 | Other | TN | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Urology
- Education
- Loma Linda University School of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
12277 Depaul Dr
Suite 201
Bridgeton, MO 63044
Phone (314) 739-8844
Hospital & facility affiliations
- SSM St Joseph Hospital West
- SSM St Clare Health Center
- SSM St Joseph Health Center
- SSM Health St Mary'S Hospital - St Louis
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Prostate resection | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A67587 | CA | MD | Urology Physician |
| MD37792 | TN | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SSM Medical Group Inc. | Current | Accepting new patients | |
| SSM Medical Group, Inc. | Current | Accepting new patients |
Locations
1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115
3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100
Interoperability endpoints
- mdickinson437701@direct-ehr-ssmhc.com
Organizations & group practices 2
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.
-
- Multi-Specialty Clinic/Center
- Fenton, MO
- NPI 1700966207
-
- Durable Medical Equipment & Medical Supplies
- Warrenton, MO
- NPI 1467997155
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1336387836
-
- General Acute Care Hospital
- Saint Charles, MO
- NPI 1467521146
-
- General Acute Care Hospital
- Fenton, MO
- NPI 1851496152
-
- General Acute Care Hospital
- Lake St Louis, MO
- NPI 1871665380
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1962572396
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643760000000",
"number": "1215914239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 CHARLOTTE AVE",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372094035",
"telephone_number": "615-250-9200",
"fax_number": "615-250-9251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 CAROTHERS PKWY",
"address_2": "STE 475",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370675980",
"telephone_number": "615-790-1660",
"fax_number": "615-790-3705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKINSON",
"first_name": "MARK",
"middle_name": "THOMAS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-30",
"last_updated": "2022-02-02",
"certification_date": "2022-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "TN",
"license": "MD37792",
"primary": true
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "CA",
"license": "A67587",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3886483",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00035782",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64069941",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "4067530",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Franklin, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; 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.