Benjamin Dickter

Primary specialty

PsychologistTaxonomy code 103T00000X

License

680 Issued in WY

Practice address

310 W Losey St
Scott Afb, IL 62225-5250

Phone

(618) 256-9355

NPI assigned

Jul 26, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1295288264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-9355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "280 1st St # 15",
            "address_purpose": "LOCATION",
            "city": "Holloman AFB",
            "state": "NM",
            "postal_code": "883308273",
            "country_code": "US",
            "telephone_number": "484-888-8492",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKTER",
        "first_name": "BENJAMIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-26",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WY",
            "license": "680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Branden Richard Crockett, D.P.T.
• Ryan Michael Davis, IDMT
• Baylee Austin Delozier, DO
• Adam Kirk Derrickson, M.D.
• Dfas-JFLL/in
• Mary Beth Doyle, MD
• Sheniqua L.N. Drakeford, MD
• Daine E. Drobek, MSW - LCSW
• Bryan D Dye, D.D.S.
• Stephen Trent Elliott, D.O.

• All providers in Scott Afb, IL
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.