NPIMap

Individual provider Active NPI

Jerome Anthony Dixon, D.O.

  • Family Medicine Physician
  • Campbellsville, KY
National Provider Identifier
1215919451
Registry record updated Dec 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02320 Issued in KY
Practice address
150 W Bear Track Rd
Campbellsville, KY 42718-8709
Phone
(270) 465-8133
Fax
(270) 789-1543
NPI assigned
Nov 15, 2005
Last updated
Dec 14, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2009

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 02320 KY
Addiction Medicine (Family Medicine) Physician 207QA0401X 02320 KY
Geriatric Medicine (Family Medicine) Physician 207QG0300X 02320 KY
Occupational Medicine Physician 2083X0100X 02320 KY
Family Medicine Physician 207Q00000X 02320 KY Primary

Addresses

Primary practice location

150 W Bear Track Rd
Campbellsville, KY 42718-8709

Mailing address

150 W Bear Track Rd
Campbellsville, KY 42718-8709
Phone (270) 465-8133

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041008000353 KY Practitioner - Family PracticePractitioner - Osteopathic Manipulative MedicinePractitioner - Geriatric MedicinePractitioner - Pain Management 5799744363 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Osteopathic Manipulative Medicine, Pain Management
Education
Ohio University, College of Osteopathic Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jerome a Dixon D O LLCGroup PAC ID 8426017229, 2 clinicians

Practice addresses (Care Compare)

150 W Bear Track Rd
Campbellsville, KY 42718-8709
Phone (270) 465-8133

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
02320KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jerome a Dixon D O LLC Family Medicine CurrentSince Sep 5, 1992 Accepting new patients
Personal Geri-Care, LLC Geriatric Medicine CurrentSince Sep 1, 2021 Accepting new patients
Campbellsville Operating Company LLC Past Accepting new patients
CNRF Operations, LLC Past Accepting new patients

Locations

150 W Bear Track Rd
Campbellsvlle, KY 42718
Phone (270) 465-8133

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Grandview Nursing and Rehabilitation FacilityCampbellsville, KY, CCN 185042 Skilled nursing facility Adp of the SNF Nov 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260748800000",
    "number": "1215919451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 W BEAR TRACK RD",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427188709",
            "telephone_number": "270-465-8133",
            "fax_number": "270-789-1543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W BEAR TRACK RD",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427188709",
            "telephone_number": "270-465-8133",
            "fax_number": "270-789-1543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIXON",
        "first_name": "JEROME",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2009-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "KY",
            "license": "02320",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "KY",
            "license": "02320",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "KY",
            "license": "02320",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "KY",
            "license": "02320",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "02320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Campbellsville, KY

Sources for this page

Verify at the official NPI Registry.