NPIMap

Individual provider Active NPI

Dionne Serena Dickerson, M.D.

  • Obstetrics & Gynecology Physician
  • Southfield, MI
National Provider Identifier
1578579652
Registry record updated Aug 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
4301074170 Issued in MI
Practice address
29255 Northwestern Hwy
Ste 200
Southfield, MI 48034-5741
Phone
(248) 355-2852
Fax
(248) 355-2853
NPI assigned
Jul 31, 2006
Last updated
Aug 2, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 4301074170 MI Primary

Addresses

Primary practice location

29255 Northwestern Hwy
Ste 200
Southfield, MI 48034-5741

Mailing address

29255 Northwestern Hwy
Ste 200
Southfield, MI 48034-5741
Phone (248) 355-2852

Other identifiers 1

IdentifierTypeStateIssuer
4622116MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031126000637 MI Practitioner - Obstetrics/Gynecology 4587568431 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Wright State University Boonshoft School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians for Women PLLCGroup PAC ID 1355448390, 2 clinicians

Practice addresses (Care Compare)

29255 Northwestern Hwy
Suite 204
Southfield, MI 48034-5741
Phone (248) 355-2852

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301074170MIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Dermatolgy Group, PC PastSince Jun 1, 2007 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470096000000",
    "number": "1578579652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29255 NORTHWESTERN HWY",
            "address_2": "STE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480345741",
            "telephone_number": "248-355-2852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29255 NORTHWESTERN HWY",
            "address_2": "STE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480345741",
            "telephone_number": "248-355-2852",
            "fax_number": "248-355-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "DIONNE",
        "middle_name": "SERENA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2016-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301074170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4622116",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.