Active NPI
Misty Dawn Baker, DPM
- Podiatrist
- Longview, TX
National Provider Identifier
1740273937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 1758
- Practice address
- 305 N 5TH St
Longview, TX 75601-6518 - Phone
- (903) 757-3338
- NPI assigned
- Aug 24, 2005
- Last updated
- Oct 1, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 1758 | TX | Primary |
Addresses
Primary practice location
305 N 5TH St
Longview, TX 75601-6518
Mailing address
305 N 5TH St
Longview, TX 75601-6518
Phone (903) 757-3338
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 176132203 | Medicaid | TX | |
| P00439882 | Other | TX | MEDICARE RAILROAD |
| 176132202 | Medicaid | TX | |
| 8BG720 | Other | TX | BCBS PIN |
| 8EC351 | Other | TX | BCBS PIN |
Other names 1
- Misty Dawn Dickson
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T1758 | TX | MD | Ophthalmology Physician |
| 1758 | TX | MD | Magnetic Resonance Imaging Radiologic Technologist |
Organizations & group practices 1
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.
-
- Podiatrist
- Longview, TX
- NPI 1174952600
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412121600000",
"number": "1740273937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 N 5TH ST",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756016518",
"telephone_number": "903-757-3338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 N 5TH ST",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756016518",
"telephone_number": "903-757-3338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAKER",
"first_name": "MISTY",
"middle_name": "DAWN",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-24",
"last_updated": "2014-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "TX",
"license": "1758",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "176132203",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00439882",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "176132202",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN",
"identifier": "8BG720",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN",
"identifier": "8EC351",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MISTY",
"last_name": "DICKSON",
"middle_name": "DAWN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.