Individual provider Active NPI

Jaime Lee Dickerson, M.D.

  • Anesthesiology Physician
  • Sacramento, CA
National Provider Identifier
1295729515
Registry record updated Dec 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
G85369 Issued in CA
Practice address
3315 Watt Ave
Sacramento, CA 95821-3600
Phone
(916) 481-6800
Fax
(916) 481-1881
NPI assigned
Aug 31, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G85369 CA Primary

Addresses

Primary practice location

3315 Watt Ave
Sacramento, CA 95821-3600

Mailing address

PO Box 660910
Sacramento, CA 95866-0910
Phone (916) 481-6800

Other identifiers 1

IdentifierTypeStateIssuer
GR0028370MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080627000499 CA Practitioner - Anesthesiology 8224100748 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Georgetown University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Anesthesia Service Exchange Medical Group IncGroup PAC ID 9638082530, 106 clinicians

Practice addresses (Care Compare)

3315 Watt Ave
Sacramento, CA 95821-3600
Phone (916) 481-6800

Hospital & facility affiliations

  • Sutter Medical Center, Sacramento Hospital, Sacramento, CA, CCN 050108

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G85369CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Anesthesia Service Exchange Medical Group, Inc. Anesthesiology CurrentSince Oct 28, 1999 Accepting new patients
Sacsolano Anesthesia Exchange Medical Group, Inc Anesthesiology Past Accepting new patients

Locations

3315 Watt Ave
Sacramento, CA 95821
Phone (916) 481-0777

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291766400000",
    "number": "1295729515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660910",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958660910",
            "telephone_number": "916-481-6800",
            "fax_number": "916-481-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 WATT AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958213600",
            "telephone_number": "916-481-6800",
            "fax_number": "916-481-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "JAIME",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2010-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G85369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0028370",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.