Kurtis Antonio Dickson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9111705 Issued in FL

Practice address

293 NW Peacock Blvd Ste 201
Port Saint Lucie, FL 34986-2222

Phone

(772) 204-8870

Fax

(772) 204-8873

NPI assigned

Sep 12, 2018

Last updated

Nov 8, 2018By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

University of Florida College of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lawnwood Healthcare Specialists LLCGroup PAC ID 4789750118, 47 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Lawnwood Hospital Hospital, Fort Pierce, FL, CCN 100246

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: kurtis.dickson@hca4.eclinicaldirectplus.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.

• Lawnwood Healthcare Specialists LLC

  • Neurological Surgery Physician
  • Fort Pierce, FL
  • NPI 1649437765
  Medicare reassignment Care Compare group
• Broward Neurosurgeons LLC

  • Neurological Surgery Physician
  • Plantation, FL
  • NPI 1366499618
  NPD (past)

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

• Lawnwood Medical Center Inc

  dba HCA Florida Lawnwood Hospital

  • General Acute Care Hospital
  • Fort Pierce, FL
  • NPI 1568409647
  Care Compare affiliation

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

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1427531771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 NW PEACOCK BLVD STE 201",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862222",
            "telephone_number": "772-204-8870",
            "fax_number": "772-204-8873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "293 NW PEACOCK BLVD STE 201",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862222",
            "telephone_number": "772-204-8870",
            "fax_number": "772-204-8873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "KURTIS",
        "middle_name": "ANTONIO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-12",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; 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.