Jonathan David Dickson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1154 Issued in AR

Practice address

1444 E Stearns St Ste 11
Fayetteville, AR 72703-4969

Phone

(479) 718-7546

NPI assigned

Feb 14, 2019

Sex

Male

Sole proprietor

Yes

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 AR

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology and Skin Cancer Center, LLCGroup PAC ID 2961588900, 8 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jdickson@adscc.emadirect.md

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.

• Advanced Dermatology & Skin Cancer Center, LLC

  • Clinic/Center
  • Fayetteville, AR
  • NPI 1245426162
  Medicare reassignment Care Compare group
• Clinical Care in Radiology

  • Physician Assistant
  • Fort Worth, TX
  • NPI 1578331393
  NPD (past)

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1487110474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1444 E STEARNS ST STE 11",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034969",
            "telephone_number": "479-718-7546",
            "fax_number": "479-966-4979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1444 E STEARNS ST STE 11",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034969",
            "telephone_number": "479-718-7546"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "492 Foster Chapel Rd",
            "address_purpose": "LOCATION",
            "city": "Searcy",
            "state": "AR",
            "postal_code": "721439605",
            "country_code": "US",
            "telephone_number": "903-530-7986",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "627 Turtle Creek Dr",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757011832",
            "country_code": "US",
            "telephone_number": "903-593-2539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "JONATHAN",
        "middle_name": "DAVID",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-14",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA13777",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-1154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Michael Dickerson, D.C.
• Megie Kathleen Dickinson, M.S. CCC-SLP
• Tiffany Rhett Dickinson
• Dickson Street Clinic
• Ernestine Dickson, MSW, LCSW
• Dawn Allyson Didier, ATC, LAT
• Shawna Kay Digby, RN, MNSC
• Bradley Dilday, M.D.
• Clarence W. Dill III, DDS
• Nicole Dill, LPC

• Physician Assistant in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.