NPIMap

Individual provider Active NPI

Kevin Dickerson, APRN

  • Certified Registered Nurse Anesthetist
  • Louisville, KY
National Provider Identifier
1629636998
Registry record updated Jun 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3013376 Issued in KY
Practice address
200 E Chestnut St
Louisville, KY 40202-1800
Phone
(502) 636-7111
NPI assigned
Jun 3, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 3013376 KY Primary

Addresses

Primary practice location

200 E Chestnut St
Louisville, KY 40202-1800

Mailing address

3112 Timberlake CT
Jeffersonville, IN 47130-7629
Phone (812) 989-9650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190621001762 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 5597099705 Reassigns benefits to 3 organizations
I20230921002274 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 5597099705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Anesthesia Services of Kentucky PLLCGroup PAC ID 0244590305, 351 clinicians
Universal Anesthesia Services LLCGroup PAC ID 9830268341, 58 clinicians

Practice addresses (Care Compare)

200 E Chestnut St
Louisville, KY 40202-1831
Phone (502) 629-8000

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088
  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
3013376KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Anesthesia Services of Kentucky PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2019 Accepting new patients
Universal Anesthesia Services LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2020 Accepting new patients
Northstar Anesthesia of Indiana LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 21, 2023 Accepting new patients

Locations

13500 Powers Ct
Ste 230
Fort Myers, FL 33912
Phone (239) 610-0784

3423 Solutions Ctr
Chicago, IL 60677

24 Joliet St
Dyer, IN 46311
Phone (219) 864-2237

200 E Chestnut St
Louisville, KY 40202
Phone (502) 446-8000

4960 Norton Healthcare Blvd
Louisville, KY 40241
Phone (502) 446-8000

231 E Chestnut St
Louisville, KY 40202
Phone (502) 852-8500

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1629636998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3112 TIMBERLAKE CT",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471307629",
            "telephone_number": "812-989-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E CHESTNUT ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021800",
            "telephone_number": "502-636-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "KEVIN",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-03",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3013376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.