Matthew Douglas Dickson, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

4064 Issued in AZ

Practice address

1628 Palm Ave
San Diego, CA 92154-1027

Phone

(619) 591-9999

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

Yes

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 CA

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

Emergency Medicine

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southbay Urgent Care IncGroup PAC ID 6406166339, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Southbay Urgent Care Inc

  • Urgent Care Clinic/Center
  • San Diego, CA
  • NPI 1558746750
  Medicare reassignment Care Compare group NPD
• KM Dickson Medical Corporation

  • General Practice Physician
  • San Diego, CA
  • NPI 1265642250
  Medicare reassignment NPD
• Senior Medical Associates, Inc.

  • Geriatric Medicine (Internal Medicine) Physician
  • San Diego, CA
  • NPI 1629253505
  Medicare reassignment NPD
• Southwest Wound Center LLC

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Yuma, AZ
  • NPI 1235414905
  NPD (past) Authorized official
• Dr Carneiro Wound Medicine Corp

  • Primary Care Clinic/Center
  • San Diego, CA
  • NPI 1942983473
  NPD
• Yuma Regional Medical Center

  • General Acute Care Hospital
  • Yuma, AZ
  • NPI 1194706655
  NPD (past)

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542672000000",
    "number": "1457388720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660969",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910660969",
            "telephone_number": "626-447-0296",
            "fax_number": "626-447-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1628 PALM AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921541027",
            "telephone_number": "619-591-9999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 S Avenue A",
            "address_purpose": "LOCATION",
            "city": "Yuma",
            "state": "AZ",
            "postal_code": "853647127",
            "country_code": "US",
            "telephone_number": "928-336-7100",
            "fax_number": "928-336-7508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "MATTHEW",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2018-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "4064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "867690",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XPY199940",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Dickmann, LVN
• Brian M Dicks, M.D.
• Janice Dickson
• Kaitlin Dickson, PA
• Kelsey Dickson, M.A.
• Jermaine Dictado, PSYD
• Ana Margarita Didasa
• Marina Didenko, LCSW
• Claire Didion, L.AC.
• Stephanie Diebold, M.D.

• Emergency Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.