Patricia A Dickerson, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

350554000 Issued in OH

Practice address

1299 E Alex Bell Rd
Centerville, OH 45459-2658

Phone

(937) 436-1117

Fax

(937) 436-9576

NPI assigned

Aug 30, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Advanced Dermatology of North Central Ohio Inc

  • Procedural Dermatology Physician
  • Mansfield, OH
  • NPI 1073528733
  Medicare reassignment NPD

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352073600000",
    "number": "1336132950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1299 E ALEX BELL RD",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454592658",
            "telephone_number": "937-436-1117",
            "fax_number": "937-436-9576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1299 E ALEX BELL RD",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454592658",
            "telephone_number": "937-436-1117",
            "fax_number": "937-436-9576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "PATRICIA",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2012-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "350554000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0866648",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anuradha Surya Devara, PA
• Mary Devault
• Caleb David Devolld, MA, LPCC-S
• Alexandra Diaz, MD
• Misty Irene Dickerson, D.O.
• Jodi Diedrich, AT, ATC
• Robert Diercks, RPH
• Kyle Lee Dieringer, DPT
• Dominic Anthony Dimarino, PT
• Fazel Dinary, M.D

• Dermatology Physician in Centerville, OH
• Providers in Centerville, OH by specialty
• Dermatology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; 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.