NPIMap

Organization Active NPI

Dickson Medical Associates, PC

Doing business as DMA Pediatrics and Specialty Clinic

  • Rural Health Clinic/Center
  • Waverly, TN
National Provider Identifier
1730835356
Registry record updated Feb 23, 2022
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 Pediatrics and Specialty Clinic
Practice address
300 S Clydeton Rd
Waverly, TN 37185-2140
Phone
(615) 446-5121
Fax
(615) 446-1359
NPI assigned
Feb 22, 2022
Last updated
Feb 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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 Primary

Addresses

Primary practice location

300 S Clydeton Rd
Waverly, TN 37185-2140

Mailing address

127 Crestview Park Dr Ste 209
Dickson, TN 37055-2856
Phone (615) 441-4478

Other names 1

  • DMA Pediatrics and Specialty Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220314002231 TN Part A Provider - Rural Health Clinic 3971408774 Practice locations: Waverly, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730835356. Details of each certification follow.

Rural health clinic certification: CCN 883924

Legal name
DICKSON MEDICAL ASSOCIATES, PC
Doing business as
DMA PEDIATRICS AND SPECIALTY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 30, 2022
Last certification
Nov 30, 2022
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jan 1, 2001 in TN
Enrollment address
300 S Clydeton Rd
Waverly, TN 37185-2140

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Dickson Medical Associate PC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 22

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 Sep 29, 2025
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%
Patrick M Luchini Individual 5% Or Greater Direct Ownership Interest Dec 30, 2025 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 Jun 24, 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 Sep 29, 2025 100%
Dolores J Lucas Individual 5% Or Greater Direct Ownership Interest Jul 1, 2007 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 Jul 23, 2014 4.93%
John Bradford McDonough Individual 5% Or Greater Direct Ownership Interest Jul 9, 2025 4.93%
Christie Strong Individual Operational/Managerial Control Jan 1, 2001
William Brewer Individual 5% Or Greater Direct Ownership Interest Mar 31, 2021 4.93%
Corporate DirectorTreasurer Jan 1, 2025
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 DirectorSecretary Jan 1, 2025

Owners & managing parties with NPI records 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1645488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1730835356",
    "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": "615-441-4478",
            "fax_number": "615-446-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S CLYDETON RD",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371852140",
            "telephone_number": "615-446-5121",
            "fax_number": "615-446-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKSON MEDICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-22",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DMA Pediatrics and Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waverly, TN

Sources for this page

Verify at the official NPI Registry.