Misty Irene Dickerson, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

34010654 Issued in OH

Practice address

7740 Washington Village Drive
Suite 100
Centerville, OH 45458-3994

Phone

(937) 531-7900

Fax

(937) 531-7901

NPI assigned

Jan 30, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

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

Specialty

Obstetrics/Gynecology

Education

Oklahoma State University College of Osteopathic Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dayton Osteopathic HospitalGroup PAC ID 7618878877, 34 clinicians

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
• Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
• Kettering Health Miamisburg Hospital, Miamisburg, OH, CCN 360239
• Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360
• Kettering Health Troy Hospital, Troy, OH, CCN 360368

Merit-based Incentive Payment System (MIPS)

Final score

81.34 of 100Reported as group

Quality

63.67

Promoting interoperability

100

Improvement activities

40

Cost

74.14

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Dayton Osteopathic Hospital

  • Multi-Specialty Clinic/Center
  • Dayton, OH
  • NPI 1588630347
  Medicare reassignment Care Compare group NPD
• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865

  Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD
• Dayton Osteopathic Hospital

  • Specialty Pharmacy
  • Kettering, OH
  • NPI 1629511688
  NPD
• Dayton Osteopathic Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1053339507
  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Beavercreek Medical Center

  • General Acute Care Hospital
  • Beavercreek, OH
  • NPI 1760764849
  Care Compare affiliation
• Dayton Osteopathic Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1053339507
  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Troy, OH
  • NPI 1023587045
  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Kettering, OH
  • NPI 1043233984
  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Miamisburg, OH
  • NPI 1316966518
  Care Compare affiliation

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1427296318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7740 WASHINGTON VILLAGE DR",
            "address_2": "SUITE 100",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594056",
            "telephone_number": "937-531-7900",
            "fax_number": "937-531-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7740 WASHINGTON VILLAGE DRIVE",
            "address_2": "SUITE 100",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454583994",
            "telephone_number": "937-531-7900",
            "fax_number": "937-531-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "MISTY",
        "middle_name": "IRENE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OH",
            "license": "34.010654",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "34010654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0076897",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdickerson514399@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "7740 Washington Village Drive",
            "address_2": "Suite 100",
            "city": "Centerville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454583994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "7740 Washington Village Drive",
            "address_2": "Suite 100",
            "city": "Centerville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454583994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Anne Derov, MA
• Anuradha Surya Devara, PA
• Mary Devault
• Caleb David Devolld, MA, LPCC-S
• Alexandra Diaz, MD
• Patricia A Dickerson, MD
• Jodi Diedrich, AT, ATC
• Robert Diercks, RPH
• Kyle Lee Dieringer, DPT
• Dominic Anthony Dimarino, PT

• Obstetrics & Gynecology Physician in Centerville, OH
• Providers in Centerville, OH by specialty
• Obstetrics & Gynecology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.

Verify at the official NPI Registry.