Active NPI
Jennifer Marie Dickerson, PA-C
- Physician Assistant
- Columbus, OH
National Provider Identifier
1528593233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2731
- Practice address
- 460 W 10TH Ave
Columbus, OH 43210-1240 - Phone
- (614) 293-3196
- Fax
- (614) 293-4812
- NPI assigned
- May 1, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2731 | SC | Primary |
Addresses
Primary practice location
460 W 10TH Ave
Columbus, OH 43210-1240
Mailing address
700 Ackerman Rd Ste 2120
Columbus, OH 43202-1559
Phone (614) 293-3196
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2731 | Other | SC | SC LICENSE |
Other names 1
- Jennifer Marie Fowler
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2731 | SC | MD | Community Health Worker |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Columbus, OH
- NPI 1740231448
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732233600000",
"number": "1528593233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 ACKERMAN RD STE 2120",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432021559",
"telephone_number": "614-293-3196",
"fax_number": "614-293-4812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 W 10TH AVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432101240",
"telephone_number": "614-293-3196",
"fax_number": "614-293-4812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "JENNIFER",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-01",
"last_updated": "2024-11-22",
"certification_date": "2024-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "2731",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SC LICENSE",
"identifier": "2731",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "FOWLER",
"middle_name": "MARIE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.