Active NPI
Timothy W Hickerson, M.D.
- Internal Medicine Physician
- Springfield, OH
National Provider Identifier
1659371045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 35055407
- Practice address
- 2331 Derr Rd
Springfield, OH 45503-2439 - Phone
- (937) 390-3040
- NPI assigned
- Jul 28, 2005
- Last updated
- Feb 12, 2008
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35055407 | OH | Primary |
Addresses
Primary practice location
2331 Derr Rd
Springfield, OH 45503-2439
Mailing address
2331 Derr Rd
Springfield, OH 45503-2439
Phone (937) 390-3040
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0771937 | Medicaid | OH | |
| 000000015901 | Other | OH | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35055407 | OH | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Crystal Clear Imaging, LLC | Past | Accepting new patients | |
| Physicians Electrocardiograms Interpretations of Springfield Inc | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Diagnostic Radiology Physician
- Springfield, OH
- NPI 1346220662
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- Internal Medicine Physician
- Springfield, OH
- NPI 1447250022
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202774400000",
"number": "1659371045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2331 DERR RD",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455032439",
"telephone_number": "937-390-3040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2331 DERR RD",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455032439",
"telephone_number": "937-390-3040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKERSON",
"first_name": "TIMOTHY",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-28",
"last_updated": "2008-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "35055407",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0771937",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000015901",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.