NPIMap

Organization Active NPI

Meadowcrest Family Physicians, P.a.

  • Family Medicine Physician
  • Crystal River, FL
National Provider Identifier
1396981528
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEADOWCREST FAMILY PHYSICIANS, P.A.
Practice address
1250 N Vantage PT Dr
Crystal River, FL 34429
Phone
(352) 795-0644
Fax
(352) 795-5950
NPI assigned
Dec 17, 2008
Last updated
Oct 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Authorized official

Name
Dr. Jimmy C Dickert, D.O.
Title
President/Physician
Phone
(352) 795-0644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1250 N Vantage PT Dr
Crystal River, FL 34429

Mailing address

1250 N Vantage PT Dr
Crystal River, FL 34429-2679
Phone (352) 795-0644

Other practice location 1

512 N Lecanto Hwy
Crystal River, Fl 34429
Lecanto, FL 34461
Phone (352) 795-0644

Other practice location 2

6199 W Gulf To Lake Hwy
Crystal River, FL 34429-2679
Phone (352) 795-0644

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051114000195 FL Part B Supplier - Clinic/Group Practice 5597784199 Receives reassigned benefits from 22 practitioners
Practice locations: Lecanto, FL; Homosassa, FL; Crystal River, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

512 N Lecanto Hwy
Fl 34429
Lecanto, FL 34461
Phone (352) 795-0644

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73059

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
Meadowcrest Family Physicians PALecanto, FL, CCN 683851 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 15, 2005

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1396981528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 N VANTAGE PT DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344292679",
            "telephone_number": "352-795-0644",
            "fax_number": "352-795-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 N VANTAGE PT DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "34429",
            "telephone_number": "352-795-0644",
            "fax_number": "352-795-5950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "512 N Lecanto Hwy",
            "address_2": "Crystal River, Fl 34429",
            "address_purpose": "LOCATION",
            "city": "Lecanto",
            "state": "FL",
            "postal_code": "34461",
            "country_code": "US",
            "telephone_number": "352-795-0644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6199 W Gulf To Lake Hwy",
            "address_purpose": "LOCATION",
            "city": "Crystal River",
            "state": "FL",
            "postal_code": "344292679",
            "country_code": "US",
            "telephone_number": "352-795-0644",
            "fax_number": "352-795-5950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEADOWCREST FAMILY PHYSICIANS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-17",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "DICKERT",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "352-795-0644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal River, FL

Sources for this page

Verify at the official NPI Registry.