NPIMap

Organization Active NPI

Jerome a Dixon D O LLC

  • Family Medicine Physician
  • Campbellsville, KY
National Provider Identifier
1508932955
Registry record updated May 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02320 Issued in KY
Legal business name
JEROME A DIXON D O LLC
Practice address
150 W Bear Track Rd
Campbellsville, KY 42718-8709
Phone
(270) 465-8133
Fax
(270) 789-1543
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2026

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

Authorized official

Name
Nissan Friedman
Title
Chief Executive Officer
Phone
(845) 521-9991

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 02320 KY Primary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X 4091P KY
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X 3007692 KY

Addresses

Primary practice location

150 W Bear Track Rd
Campbellsville, KY 42718-8709

Mailing address

150 W Bear Track Rd
Campbellsville, KY 42718-8709
Phone (270) 465-8133

Other identifiers 1

IdentifierTypeStateIssuer
64023203MedicaidKY

Other names 1

  • Jerome A. Dixon, D.O., P.S.C. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041007000436 KY Part B Supplier - Clinic/Group Practice 8426017229 Receives reassigned benefits from 3 practitioners
Practice locations: Campbellsville, KY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779235200000",
    "number": "1508932955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 W BEAR TRACK RD",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427188709",
            "telephone_number": "270-465-8133",
            "fax_number": "270-789-1543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W BEAR TRACK RD",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427188709",
            "telephone_number": "270-465-8133",
            "fax_number": "270-789-1543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROME A DIXON D O LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-20",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "NISSAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "845-521-9991"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "02320",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "4091P",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3007692",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64023203",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jerome A. Dixon, D.O., P.S.C.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jerome A. Dixon, D.O., P.S.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Campbellsville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.