NPIMap

Organization Active NPI

Dickson Medical Associates, PC

Doing business as DMA Fairview

  • Rural Health Clinic/Center
  • Fairview, TN
National Provider Identifier
1710565205
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DICKSON MEDICAL ASSOCIATES, PC
Doing business as
DMA Fairview
Practice address
2340 Fairview Blvd Ste 100
Fairview, TN 37062-9458
Phone
(629) 205-3018
Fax
(615) 446-1357
NPI assigned
Mar 29, 2021
Last updated
Jul 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Authorized official

Name
Christie Strong
Title
Executive Director
Phone
(615) 446-1324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2340 Fairview Blvd Ste 100
Fairview, TN 37062-9458

Mailing address

127 Crestview Park Dr Ste 209
Dickson, TN 37055-2856
Phone (615) 446-5121

Other names 1

  • DMA Fairview Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210517000856 TN Part A Provider - Rural Health Clinic 3971408774 Practice locations: Fairview, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710565205. Details of each certification follow.

Rural health clinic certification: CCN 883917

Legal name
DICKSON MEDICAL ASSOCIATES, PC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 7, 2022
Last certification
Sep 7, 2022
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jan 1, 2001 in TN
Enrollment address
2340 Fairview Blvd
Ste 100
Fairview, TN 37062-9458

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2153987Dickson Medical Associates-Fairview2340 Fairview Blvd, Fairview, TN 37062Certificate of waiverSep 3, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kerry W Ross Individual 5% Or Greater Direct Ownership Interest Jul 26, 2004 4.93%
Corporate OfficerVice President Jan 1, 2020 100%
Jeffrey Alan Culp Individual 5% Or Greater Direct Ownership Interest Nov 6, 2023 4.93%
Demond C White Individual 5% Or Greater Direct Ownership Interest Apr 1, 2014 4.93%
Matthew L Sarb Individual 5% Or Greater Direct Ownership Interest Apr 1, 2022 4.93%
Deline Kirubanathan Individual 5% Or Greater Direct Ownership Interest Apr 1, 2022 4.93%
Caroline Farrar Individual 5% Or Greater Direct Ownership Interest Jul 9, 2025 4.93%
Daniel J Sherwood Individual 5% Or Greater Direct Ownership Interest Nov 1, 2020 4.93%
Mary K McNeal Individual 5% Or Greater Direct Ownership Interest Sep 1, 2004 4.93%
Corporate OfficerPresident Jan 1, 2020 100%
Dolores J Lucas Individual General Partnership Interest Jan 24, 2021 2.4%
David J Blazer Individual 5% Or Greater Direct Ownership Interest Jan 1, 2001 4.43%
Enawgaw B Mehari Individual 5% Or Greater Direct Ownership Interest May 1, 2023 4.93%
Vera H Huffnagle Individual 5% Or Greater Direct Ownership Interest Jan 1, 2001 4.93%
Ehab S Kasasbeh Individual 5% Or Greater Direct Ownership Interest Apr 1, 2014 4.93%
John Bradford McDonough Individual 5% Or Greater Direct Ownership Interest Jun 24, 2025 4.93%
Christie Strong Individual Operational/Managerial ControlExecutive Director Sep 1, 2018 100%
William Brewer Individual 5% Or Greater Direct Ownership Interest Mar 3, 2021 4.93%
Corporate OfficerTreasurer Sep 29, 2025 100%
Abigail L Ryan Individual 5% Or Greater Direct Ownership Interest Nov 6, 2023 4.93%
David L Ross Individual 5% Or Greater Direct Ownership Interest Aug 1, 2004 4.93%
Robert W Orgain Individual 5% Or Greater Direct Ownership Interest May 29, 1987 4.43%
Mohammad a Alsoub Individual 5% Or Greater Direct Ownership Interest Apr 1, 2022 4.93%
Howard M Hammer Individual 5% Or Greater Direct Ownership Interest Feb 15, 2024 4.93%
Corporate OfficerSecretary Sep 29, 2025 100%

Owners & managing parties with NPI records 20

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625097600000",
    "number": "1710565205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 CRESTVIEW PARK DR STE 209",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552856",
            "telephone_number": "615-446-5121",
            "fax_number": "615-446-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 FAIRVIEW BLVD STE 100",
            "city": "FAIRVIEW",
            "state": "TN",
            "postal_code": "370629458",
            "telephone_number": "629-205-3018",
            "fax_number": "615-446-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKSON MEDICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-29",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A",
        "authorized_official_last_name": "STRONG",
        "authorized_official_first_name": "CHRISTIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "615-446-1324"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DMA Fairview",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DMA Fairview",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairview, TN

Sources for this page

Verify at the official NPI Registry.