Russell Eric Dickenson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

100 Issued in TN

Practice address

10800 Parkside Dr Ste 331
Knoxville, TN 37934-1922

Phone

(865) 392-3400

Fax

(865) 392-3449

NPI assigned

Oct 26, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

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, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Knoxville Hma Cardiology PPM, LLCGroup PAC ID 1658542758, 42 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Physicians Regional Medical Center Hospital, Powell, TN, CCN 440120
• Tennova Healthcare - Newport Medical Center Hospital, Newport, TN, CCN 440153
• Tennova Healthcare-Jefferson Memorial Hospital Hospital, Jefferson City, TN, CCN 440056

Merit-based Incentive Payment System (MIPS)

Final score

88.07 of 100Reported as apm

Quality

73.89

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: russell.eric.dickenson.1@10667.direct.athenahealth.com

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.

• Knoxville Hma Cardiology PPM, LLC

  • Cardiovascular Disease Physician
  • Knoxville, TN
  • NPI 1275811713
  Medicare reassignment Care Compare group
• MPS-Cardiology LLC

  • Cardiovascular Disease Physician
  • Knoxville, TN
  • NPI 1023092426
  NPD

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

• Cocke County Hma, LLC

  • General Acute Care Hospital
  • Newport, TN
  • NPI 1972576247
  Care Compare affiliation
• Jefferson County Hma LLC

  • General Acute Care Hospital
  • Jefferson City, TN
  • NPI 1972585347
  Care Compare affiliation
• Metro Knoxville Hma LLC

  • General Acute Care Hospital
  • Powell, TN
  • NPI 1043292899
  Care Compare affiliation

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1497745814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 PARKSIDE DR STE 331",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379341922",
            "telephone_number": "865-392-3400",
            "fax_number": "865-392-3449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 PARKSIDE DR STE 331",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379341922",
            "telephone_number": "865-392-3400",
            "fax_number": "865-392-3449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKENSON",
        "first_name": "RUSSELL",
        "middle_name": "ERIC",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3665210",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "russell.eric.dickenson.1@10667.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "10800 Parkside Dr Ste 331",
            "city": "Knoxville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "379341922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Dickens, MD
• Patrick Dickens
• Samantha Dickens
• Dickenson Dental
• Brent M. Dickenson, D.D.S.
• David Wesley Dickey III, DDS
• Pamela Austin Dickey, LCSW
• Katherine Dickinson
• Robert Dickinson
• Laura Nicole Dickson

• Physician Assistant in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.