NPIMap

Individual provider Active NPI

Tina Marie Dickinson, AGPCNP-BC

  • Acute Care Nurse Practitioner
  • Newark, NY
National Provider Identifier
1306337381
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
F308478-1 Issued in NY
Practice address
1200 Driving Park Ave
Newark, NY 14513-1090
Phone
(315) 359-2847
Fax
(315) 359-2806
NPI assigned
May 24, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X F308478-1 NY Primary

Addresses

Primary practice location

1200 Driving Park Ave
Newark, NY 14513-1090

Mailing address

Newark Wayne Community Hospital 111 Driving Park Ave
Box 111, Emergency Department
Newark, NY 14513
Phone (315) 359-2847

Other names 1

  • Miss Tina Marie Jock Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tina.dickinson@rochesterregional.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20180724002628 NY Practitioner - Nurse Practitioner 5890042709 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clifton Springs Sanitarium CoGroup PAC ID 5092704809, 230 clinicians

Practice addresses (Care Compare)

2 Coulter Rd
Clifton Springs, NY 14432-1122
Phone (315) 462-5711

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F308478-1NYMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clifton Springs Sanitarium Co CurrentSince Jul 16, 2018 Accepting new patients
Rochester General Hospital CurrentSince Jul 16, 2018 Accepting new patients
Newark Wayne Community Hospital CurrentSince Jul 16, 2018 Accepting new patients
Western New York Medical Practice P.C. CurrentSince Oct 9, 2019 Accepting new patients
Rochester General Hospital CurrentSince Jul 16, 2018 Accepting new patients
Newark Wayne Community Hospital CurrentSince Jul 16, 2018 Accepting new patients
Rochester General Hospital Current Accepting new patients

Locations

2 Coulter Rd
Clifton Springs, NY 14432
Phone (315) 462-1472

111 Driving Park Ave
#111
Newark, NY 14513

1200 Driving Park Ave
Newark, NY 14513
Phone (315) 332-2266

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

Interoperability endpoints

  • Direct secure messaging: tdickinson102633@direct.rochesterregional.org

Organizations & group practices 7

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 3

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": "1527120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1306337381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NEWARK WAYNE COMMUNITY HOSPITAL 111 DRIVING PARK AVE",
            "address_2": "BOX 111, EMERGENCY DEPARTMENT",
            "city": "NEWARK",
            "state": "NY",
            "postal_code": "14513",
            "telephone_number": "315-359-2847",
            "fax_number": "315-359-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 DRIVING PARK AVE",
            "city": "NEWARK",
            "state": "NY",
            "postal_code": "145131090",
            "telephone_number": "315-359-2847",
            "fax_number": "315-359-2806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKINSON",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-24",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "F308478-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tina.dickinson@rochesterregional.org",
            "affiliation": "N",
            "address_1": "1200 Driving Park Ave",
            "city": "Newark",
            "state": "NY",
            "country_code": "US",
            "postal_code": "145131090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "JOCK",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Newark, NY

Sources for this page

Verify at the official NPI Registry.