NPIMap

Individual provider Active NPI

John R Dickerson, M.D.

  • Neurological Surgery Physician
  • Wichita, KS
National Provider Identifier
1225059025
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
0430242 Issued in KS
Practice address
3223 N Webb Rd
Suite 1
Wichita, KS 67226-8175
Phone
(316) 609-2600
Fax
(316) 609-2800
NPI assigned
Jul 21, 2006
Last updated
Jan 31, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 0430242 KS Primary

Addresses

Primary practice location

3223 N Webb Rd
Suite 1
Wichita, KS 67226-8175

Mailing address

3223 N Webb Rd
Suite 1
Wichita, KS 67226-8175
Phone (316) 609-2600

Other identifiers 1

IdentifierTypeStateIssuer
100641370CMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20050527000630 KS Practitioner - Neurosurgery 1759320765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Baylor College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Abay Neuroscience Center LLCGroup PAC ID 4183666720, 16 clinicians

Practice addresses (Care Compare)

3223 N Webb Rd
Suite 1
Wichita, KS 67226-8176
Phone (316) 609-2600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.09 of 100Reported as individual
Quality
86.65
Improvement activities
40
Cost
78.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion546
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10
Laminectomy or laminotomy (partial removal of spine bones)417
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Abay Neuroscience Center LLC CurrentSince Jun 1, 2005 Accepting new patients
Kansas Spine & Specialty Hospital, L.L.C. Past Accepting new patients

Locations

3223 N Webb Rd
Ste 1
Wichita, KS 67226
Phone (316) 609-2667

3305 E Douglas Ave
Ste 101
Wichita, KS 67218
Phone (316) 425-0005

Interoperability endpoints

  • Direct secure messaging: jdickerson@ksh.securechart.com
  • Direct secure messaging: john.dickerson@khindirect.org

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
Kansas Spine & Specialty Hospital LLCWichita, KS, CCN 170196 Hospital 5% Or Greater Indirect Ownership Interest (9.74%) Jan 1, 2007

Owned or controlled facilities with NPI records 2

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

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, 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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1225059025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3223 N WEBB RD",
            "address_2": "SUITE 1",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672268175",
            "telephone_number": "316-609-2600",
            "fax_number": "316-609-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3223 N WEBB RD",
            "address_2": "SUITE 1",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672268175",
            "telephone_number": "316-609-2600",
            "fax_number": "316-609-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "JOHN",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "KS",
            "license": "0430242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100641370C",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.