NPIMap

Organization Active NPI

Dickson Medical Associates PC

Doing business as Dickson Medical Associates Crestview Walk In

  • Rural Health Clinic/Center
  • Dickson, TN
National Provider Identifier
1285227470
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DICKSON MEDICAL ASSOCIATES PC
Doing business as
Dickson Medical Associates Crestview Walk In
Practice address
127 Crestview Park Dr Ste 112
Dickson, TN 37055-2854
Phone
(615) 441-4533
Fax
(615) 446-1359
NPI assigned
Feb 18, 2021
Last updated
Nov 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Authorized official

Name
Christie Strong
Title
Executive Director
Phone
(615) 446-1324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

127 Crestview Park Dr Ste 112
Dickson, TN 37055-2854

Mailing address

127 Crestview Park Dr Ste 209
Dickson, TN 37055-2856
Phone (615) 446-5121

Other names 1

  • Dickson Medical Associates Crestview Walk In Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210302000375 TN Part A Provider - Rural Health Clinic 3971408774 Practice locations: Dickson, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285227470. Details of each certification follow.

Rural health clinic certification: CCN 883854

Legal name
DICKSON MEDICAL ASSOCIATES, PC
Doing business as
DICKSON MEDICAL ASSOCIATES CRESTVIEW WALK-IN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 2, 2021
Last certification
Nov 2, 2021
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jan 1, 2001 in TN
Enrollment address
127 Crestview Park Dr
Ste 112
Dickson, TN 37055-2854

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Dickson Medical Associate PC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kerry W Ross Individual 5% Or Greater Direct Ownership Interest Jul 26, 2004 7.04%
Corporate OfficerPresident Jan 1, 2020
Demond C White Individual 5% Or Greater Direct Ownership Interest Apr 1, 2014 7.04%
Corporate OfficerVice President Jan 1, 2020
Daniel J Sherwood Individual 5% Or Greater Direct Ownership Interest Nov 1, 2020 7.04%
John Morse Individual General Partnership Interest Jan 24, 2021 4.93%
Mary K McNeal Individual 5% Or Greater Direct Ownership Interest Sep 1, 2004 7.04%
Corporate OfficerSecretary Jan 1, 2020
Dolores J Lucas Individual General Partnership Interest Jan 24, 2021 3.52%
David J Blazer Individual 5% Or Greater Direct Ownership Interest Jan 1, 2004 7.04%
Vera H Huffnagle Individual 5% Or Greater Direct Ownership Interest Jan 1, 2001 7.04%
Ehab S Kasasbeh Individual 5% Or Greater Direct Ownership Interest Apr 1, 2014 7.04%
Rolland Luplow Individual 5% Or Greater Direct Ownership Interest Nov 27, 1991 7.04%
Christie Strong Individual Operational/Managerial Control May 12, 2018
William Brewer Individual 5% Or Greater Direct Ownership Interest Mar 31, 2021 7.04%
Juan S Dinkins Individual 5% Or Greater Direct Ownership Interest Mar 1, 2008 7.04%
David L Ross Individual 5% Or Greater Direct Ownership Interest Aug 1, 2004 7.04%
Robert W Orgain Individual 5% Or Greater Direct Ownership Interest May 29, 1987 7.04%
Giacomo Mohondas Meeker Individual 5% Or Greater Direct Ownership Interest Aug 14, 2020 7.04%
Corporate OfficerTreasurer Jan 1, 2020

Owners & managing parties with NPI records 15

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638230400000",
    "number": "1285227470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 CRESTVIEW PARK DR STE 209",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552856",
            "telephone_number": "615-446-5121",
            "fax_number": "615-446-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 CRESTVIEW PARK DR STE 112",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552854",
            "telephone_number": "615-441-4533",
            "fax_number": "615-446-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKSON MEDICAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A",
        "authorized_official_last_name": "STRONG",
        "authorized_official_first_name": "CHRISTIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "615-446-1324"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dickson Medical Associates Crestview Walk In",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dickson, TN

Sources for this page

Verify at the official NPI Registry.