Individual provider Active NPI

Jennifer A Dickerson, M.D.

  • Cardiovascular Disease Physician
  • Mansfield, OH
National Provider Identifier
1598887341
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
35.082960 Issued in OH
Practice address
335 Glessner Ave
Mansfield, OH 44903-2269
Phone
(567) 241-7000
Fax
(567) 241-7523
NPI assigned
Apr 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 35.082960 OH Primary

Addresses

Primary practice location

335 Glessner Ave
Mansfield, OH 44903-2269

Mailing address

5400 Frantz Rd Ste 250
Dublin, OH 43016-6102

Other practice location 1

410 W 10th Ave
Columbus, OH 43210-1240
Phone (614) 293-4967

Other identifiers 1

IdentifierTypeStateIssuer
2826820MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jdickerson162720@direct.ohiohealth.com OhioHealth Physician Group

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080619000659 OH Practitioner - Cardiovascular Disease (Cardiology) 1355412214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Wright State University Boonshoft School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ohiohealth CorporationGroup PAC ID 6305758426, 2,295 clinicians

Practice addresses (Care Compare)

111 S Grant Ave
Columbus, OH 43215-4701

111 S Grant Ave 3Rd FL
Columbus, OH 43215-4701
Phone (614) 566-9184

1325 Clark St
Cambridge, OH 43725-9614
Phone (740) 630-9708

1335 Clark St
Cambridge, OH 43725-9614
Phone (740) 432-2144

1341 Clark St
Cambridge, OH 43725-9614
Phone (740) 435-2873

199 W Main St
Shelby, OH 44875-1490

335 Glessner Ave
Mansfield, OH 44903-2269

393 E Town St
Columbus, OH 43215-4799

Hospital & facility affiliations

  • Ohiohealth Mansfield Hospital Hospital, Mansfield, OH, CCN 360118
  • Ohiohealth Shelby Hospital Hospital, Shelby, OH, CCN 361324
  • University Hospitals Samaritan Medical Center Hospital, Ashland, OH, CCN 360002
  • Mercy Health - Willard Hospital Hospital, Willard, OH, CCN 361310
  • Grant Medical Center Hospital, Columbus, OH, CCN 360017

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ohiohealth Corporation CurrentSince Dec 30, 2016 Accepting new patients
Ohiohealth Corporation CurrentSince Dec 30, 2016 Accepting new patients
Ohiohealth Corporation Cardiovascular Disease Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

Dept L3652
Columbus, OH 43260

393 E Town St
Ste 116
Columbus, OH 43215
Phone (614) 566-9108

5400 Frantz Rd
Ste 250
Dublin, OH 43016
Phone (614) 544-6161

335 Glessner Ave
Mansfield, OH 44903
Phone (419) 522-0320

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1598887341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 FRANTZ RD STE 250",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430166102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 GLESSNER AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449032269",
            "telephone_number": "567-241-7000",
            "fax_number": "567-241-7523"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "410 W 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432101240",
            "country_code": "US",
            "telephone_number": "614-293-4967",
            "fax_number": "614-293-5614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35.082960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2826820",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdickerson162720@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group",
            "address_1": "335 Glessner Ave",
            "city": "Mansfield",
            "state": "OH",
            "country_code": "US",
            "postal_code": "449032269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mansfield, OH

Sources for this page

Verify at the official NPI Registry.