Jacob Dickerson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

008310 Issued in KY

Practice address

6008 Brownsboro Park Blvd
Louisville, KY 40207-1295

NPI assigned

Aug 6, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Omspt Holdings LLCGroup PAC ID 1850789066, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Omspt Holdings LLC

  • Physical Therapist
  • Louisville, KY
  • NPI 1801561592
  Medicare reassignment Care Compare group NPD
• Omspt Holdings LLC

  • Physical Therapist
  • Nashville, TN
  • NPI 1962193482
  NPD
• Omspt Holdings LLC

  • Physical Therapist
  • Fort Myers, FL
  • NPI 1194485367
  NPD (past)
• Omspt Holdings LLC

  • Physical Therapist
  • Nashville, TN
  • NPI 1790445062
  NPD (past)

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

{
    "created_epoch": "1628208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1730853292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 DANA MARIE DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402233408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6008 BROWNSBORO PARK BLVD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402071295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-06",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "008310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Robert Dick, D.M.D.
• John Dickens, MD, MBA
• Jenna A Dickenson, PSY.D.
• Dickerson Family Enterprise, LLC
• Donald Richard Dickerson III, MD STUDENT
• Janae Dickerson
• Kevin Dickerson, APRN
• Crystal Dickey
• Kevin Juhno Dickhaut, D.C.
• Ida Dickie

• Physical Therapist in Louisville, KY
• Providers in Louisville, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; 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.