Makayla Marie Dickovich, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

424 W State Highway 5
Waconia, MN 55387-1795

Phone

(952) 442-4461

Fax

(952) 442-1547

NPI assigned

May 15, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeview Clinic, LTD.Group PAC ID 6002801453, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ridgeview Medical Center Hospital, Waconia, MN, CCN 240056

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: makayladickovich@tv.allscriptsdirect.net

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.

• Lakeview Clinic, LTD.

  • Multi-Specialty Clinic/Center
  • Waconia, MN
  • NPI 1669599981
  Medicare reassignment Care Compare group
• Ridgeview Medical Center

  • Diagnostic Radiology Physician
  • Waconia, MN
  • NPI 1811174923
  NPD (past)

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

• Ridgeview Medical Center

  • General Acute Care Hospital
  • Waconia, MN
  • NPI 1275608457
  Care Compare affiliation
• Ridgeview Medical Center

  • General Acute Care Hospital
  • Chaska, MN
  • NPI 1710748538
  Care Compare affiliation

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1457042236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 W STATE HIGHWAY 5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871795",
            "telephone_number": "952-442-4461",
            "fax_number": "952-442-1547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 W STATE HIGHWAY 5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871795",
            "telephone_number": "952-442-4461",
            "fax_number": "952-442-1547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKOVICH",
        "first_name": "MAKAYLA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dayrides, Inc
• Laresa G Deboer, M.D.
• Rebecca Theresa Dekkers, LMFT
• Samuel R Deweese, M.D.
• Daniel P Dewey, MD
• Erin Marie Dolan, PA-C
• Gary Edward Donaldson, MSED
• Katherine Dougherty, M.S.
• Cindy Doyscher, F.N.P
• Mark William Doyscher, M.D.

• Medical Physician Assistant in Waconia, MN
• Providers in Waconia, MN by specialty
• Medical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.