NPIMap

Individual provider Active NPI

Andrea Karen Dickerson, MD

  • Obstetrics & Gynecology Physician
  • Fayetteville, NC
National Provider Identifier
1255323176
Registry record updated Jul 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
200000043 Issued in NC
Practice address
2053 Valleygate Dr
Ste. 201
Fayetteville, NC 28304-3688
Phone
(910) 484-9020
Fax
(910) 484-9012
NPI assigned
Aug 17, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 200000043 NC Primary

Addresses

Primary practice location

2053 Valleygate Dr
Ste. 201
Fayetteville, NC 28304-3688

Mailing address

2053 Valleygate Dr
Ste. 201
Fayetteville, NC 28304-3747
Phone (910) 484-9020

Other identifiers 1

IdentifierTypeStateIssuer
89125OJMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20040413000400 NC Practitioner - Obstetrics/Gynecology 1850385238 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of North Carolina at Chapel Hill School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCPC-12 LLCGroup PAC ID 7416198890, 32 clinicians

Practice addresses (Care Compare)

145 Applecross Rd
Pinehurst, NC 28374-8521
Phone (910) 692-7928

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200000043NCMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
A Womans Place in Fayetteville PLLC Obstetrics & Gynecology CurrentSince Jan 26, 2004 Accepting new patients
MCPC-12, LLC CurrentSince Jul 7, 2025 Accepting new patients
MCPC-12, LLC Obstetrics & Gynecology CurrentSince Jul 7, 2025 Accepting new patients
FHPG, LLC Past Accepting new patients

Locations

2053 Valleygate Dr
Ste 201
Fayetteville, NC 28304
Phone (910) 484-9020

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10421/brand/1/csg/1/fhir/r4
  • Direct secure messaging: andrea.dickerson.1@10421.direct.athenahealth.com
  • Direct secure messaging: adickerson126722@firsthealth.direct-ci.net

Organizations & group practices 4

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.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1255323176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2053 VALLEYGATE DR",
            "address_2": "STE. 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043747",
            "telephone_number": "910-484-9020",
            "fax_number": "910-484-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2053 VALLEYGATE DR",
            "address_2": "STE. 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043688",
            "telephone_number": "910-484-9020",
            "fax_number": "910-484-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "ANDREA",
        "middle_name": "KAREN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-17",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "200000043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89125OJ",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.