Individual provider Active NPI

Jonathan Charles Dyckman, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Yonkers, NY
National Provider Identifier
1366081697
Registry record updated May 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
402902 Issued in NY
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

Updated by the provider on May 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210715001525 NY Practitioner - Nurse Practitioner 0244632065 Reassigns benefits to 1 organization

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
Carmel Psychological Health PCGroup PAC ID 4385530351, 222 clinicians

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

LicenseStateTypeSpecialty
682002NYMDPsychiatric/Mental Health Registered Nurse
402902NYMDPsychiatric/Mental Health Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.