Active NPI
Alec Dickerson, DPM
- Student in an Organized Health Care Education/Training Program
- Montgomery, OH
National Provider Identifier
1548020464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 10500 Montgomery Rd
Montgomery, OH 45242-4402 - Phone
- (513) 865-1625
- NPI assigned
- Mar 19, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
10500 Montgomery Rd
Montgomery, OH 45242-4402
Mailing address
1607 E Crystal Dr
La Grange, KY 40031-2304
Phone (502) 905-2077
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240618000613 | OH | Order and Referring Only - Podiatry | 7214470327 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710979200000",
"number": "1548020464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1607 E CRYSTAL DR",
"city": "LA GRANGE",
"state": "KY",
"postal_code": "400312304",
"telephone_number": "502-905-2077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10500 MONTGOMERY RD",
"city": "MONTGOMERY",
"state": "OH",
"postal_code": "452424402",
"telephone_number": "513-865-1625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "ALEC",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-19",
"last_updated": "2024-03-21",
"certification_date": "2024-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.