Individual provider Active NPI

Cheryl Dickson, MD

  • Pediatrics Physician
  • Kalamazoo, MI
National Provider Identifier
1326139270
Registry record updated Feb 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301104278 Issued in MI
Practice address
1000 Oakland Drive
Kalamazoo, MI 49008
Phone
(269) 337-6400
NPI assigned
Sep 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2014

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X 25MA03976200 NJ
Pediatrics Physician 208000000X 25MA03976200 NJ
Pediatrics Physician 208000000X MA39762 NJ
Pediatrics Physician 208000000X 4301104278 MI Primary

Addresses

Primary practice location

1000 Oakland Drive
Kalamazoo, MI 49008

Mailing address

1000 Oakland Drive
Kalamazoo, MI 49008
Phone (269) 337-4507

Other identifiers 1

IdentifierTypeStateIssuer
2059002MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20141120000485 MI Practitioner - Pediatric Medicine 4880630789 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA03976200NJMDPediatric Emergency Medicine (Emergency Medicine) Physician
4301104278MIMDPediatrics Physician
MA39762NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Western Michigan University School of Medicine CurrentSince Dec 1, 2014 Accepting new patients
Michigan State University Kalamazoo Center for Medical Studies Past Accepting new patients

Locations

1000 Oakland Dr
Kalamazoo, MI 49008
Phone (269) 337-4347

1000 Oakland Dr
Fl 3
Kalamazoo, MI 49008
Phone (269) 387-7004

670 Mall Dr
Portage, MI 49024
Phone (269) 327-1900

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Centrica Care NavigatorsKalamazoo, MI, CCN 231505 Hospice Corporate Director Dec 7, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392940800000",
    "number": "1326139270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DRIVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "49008",
            "telephone_number": "269-337-4507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DRIVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "49008",
            "telephone_number": "269-337-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "CHERYL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2014-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "NJ",
            "license": "25MA03976200",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA03976200",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA39762",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301104278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2059002",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.