John Graham Dickerson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20810 Issued in SC

Practice address

1800 Drayton Rd Ste 313
Drayton, SC 29333-7002

Phone

(864) 415-1540

NPI assigned

May 18, 2006

Last updated

Sep 21, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

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

Practice roles

Interoperability endpoints

• Direct secure messaging: john.dickerson@5182044569604.direct.elationemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mary Black Health System LLC

  dba Mary Black Health System Spartanburg

  • Psychiatric Hospital Unit
  • Spartanburg, SC
  • NPI 1992758296
  NPD (past)
• Mary Black Physicians Group LLC

  • Family Medicine Physician
  • Spartanburg, SC
  • NPI 1295823045
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1376596593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 DRAYTON RD STE 313",
            "city": "DRAYTON",
            "state": "SC",
            "postal_code": "293337002",
            "telephone_number": "864-415-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 DRAYTON RD STE 313",
            "city": "DRAYTON",
            "state": "SC",
            "postal_code": "293337002",
            "telephone_number": "864-415-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "JOHN",
        "middle_name": "GRAHAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "20810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208108",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD PTAN",
            "identifier": "P00386791",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sparkle City Chiropractic LLC
• Spartanburg Medical Center (Spartanburg Regional Hospice)
• Spartanburg Medical Center (Regional Physician Medical Services)
• Laura K Taylor, D.C.

• Family Medicine Physician in Drayton, SC
• Providers in Drayton, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.