Karen Dickerson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA566 Issued in ID

Practice address

1352 E Center St
Pocatello, ID 83201-4734

Phone

(208) 234-2001

Fax

(208) 232-2195

NPI assigned

Aug 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdickerson1162758@ahs.direct-ci.com

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.

• Pocatello Health Services, LLC

  • Durable Medical Equipment & Medical Supplies
  • Pocatello, ID
  • NPI 1154089126
  NPD
• Compassionate Concierge Physicians, LLC

  • Family Medicine Physician
  • Longmont, CO
  • NPI 1003452301
  NPD
• Pocatello Cardiology Associates

  • Adult Health Clinical Nurse Specialist
  • Pocatello, ID
  • NPI 1659540292
  NPD (past)
• Compassionate Concierge Physicians, LLC

  • Internal Medicine Physician
  • Longmont, CO
  • NPI 1851074140
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760597462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX O",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832050049",
            "telephone_number": "208-234-2001",
            "fax_number": "208-232-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1352 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014734",
            "telephone_number": "208-234-2001",
            "fax_number": "208-232-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "KAREN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073207000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diabetes and Internal Medicine
• Diagnostic Imaging Service of Idaho
• Diagnostic Radiologists of South Florida, P.a.
• Dialysis Clinic Inc (DCI Pocatello)
• Diamond Peak Health Care LLC
• John Hanford Dickey, PH.D.
• Britt Dickman
• Sarah Didonna, MD
• Krista Michelle Diekemper, RD, LD
• Carol Jane Dillon, LPC PROFESSIONAL LIC

• Medical Physician Assistant in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.