NPIMap

Individual provider Active NPI

Sara Dickerson, FNP-C

  • Primary Care Nurse Practitioner
  • Gold Beach, OR
National Provider Identifier
1659616571
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
F06192407 Issued in OR
Practice address
29984 Ellensburg Ave
Gold Beach, OR 97444
Phone
(541) 247-7084
NPI assigned
Dec 4, 2012
Last updated
Oct 27, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered Nurse 163WW0000X 201041867RN OR
Primary Care Nurse Practitioner 363LP2300X F06192407 OR Primary

Addresses

Primary practice location

29984 Ellensburg Ave
Gold Beach, OR 97444

Mailing address

PO Box 493
Gold Beach, OR 97444-0493
Phone (541) 247-7084

Other identifiers 1

IdentifierTypeStateIssuer
F06192407OtherAMERICAN ACADEMY OF NURSE PRACTIONERS

Other names 1

  • Miss Sara E Dickerson Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20200316001204 OR Practitioner - Nurse Practitioner 8921436486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

29641 Ellensburg Ave
Gold Beach, OR 97444-8701
Phone (541) 425-5657

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F06192407ORMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Coast Healthcare LLC CurrentSince Sep 1, 2020 Accepting new patients
County of Curry Past Accepting new patients
South Coast Health Care Corp Past Accepting new patients
County of Curry Past Accepting new patients

Locations

29641 Ellensburg Ave
Gold Beach, OR 97444
Phone (541) 425-5657

Interoperability endpoints

  • Direct secure messaging: sara.dickerson.1@21678.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/21678/brand/1/csg/1/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1354579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1659616571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 493",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "974440493",
            "telephone_number": "541-247-7084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29984 ELLENSBURG AVE",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "97444",
            "telephone_number": "541-247-7084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "SARA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-04",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "OR",
            "license": "201041867RN",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OR",
            "license": "F06192407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ACADEMY OF NURSE PRACTIONERS",
            "identifier": "F06192407",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "DICKERSON",
            "middle_name": "E",
            "prefix": "MISS",
            "credential": "NP-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Gold Beach, OR

Sources for this page

Verify at the official NPI Registry.