Active NPI
Jonathan Charles Dyckman, PMHNP
- Psychiatric/Mental Health Nurse Practitioner
- Yonkers, NY
National Provider Identifier
1366081697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 402902
- Practice address
- 127 S Broadway
Yonkers, NY 10701-4006 - Phone
- (845) 392-2338
- NPI assigned
- Jan 3, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 682002 | NY | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 402902 | NY | Primary |
Addresses
Primary practice location
127 S Broadway
Yonkers, NY 10701-4006
Mailing address
127 S Broadway
Yonkers, NY 10701-4006
Phone (914) 378-7546
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2510 Route 44
Suite F
Salt Point, NY 12578-8040
Phone (845) 768-3178
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 682002 | NY | MD | Psychiatric/Mental Health Registered Nurse |
| 402902 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
Interoperability endpoints
- cpa.jonathandyckman@142175.advancedmd-direct.com
Organizations & group practices 1
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.
-
- Psychologist
- Carmel, NY
- NPI 1720194335
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589328000000",
"number": "1366081697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "127 S BROADWAY",
"city": "YONKERS",
"state": "NY",
"postal_code": "107014006",
"telephone_number": "914-378-7546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "127 S BROADWAY",
"city": "YONKERS",
"state": "NY",
"postal_code": "107014006",
"telephone_number": "845-392-2338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYCKMAN",
"first_name": "JONATHAN",
"middle_name": "CHARLES",
"credential": "PMHNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-03",
"last_updated": "2020-05-13",
"certification_date": "2020-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "NY",
"license": "682002",
"primary": false
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "NY",
"license": "402902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Yonkers, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2020; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.