Clark Bart Dickson, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

CD046491 Issued in MI

Practice address

29201 Telegraph Rd
Suite 500
Southfield, MI 48034-1331

Phone

(248) 569-5985

Fax

(248) 569-3704

NPI assigned

Dec 23, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Otolaryngology

Education

University of Cincinnati College of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ear Nose and Throat Consultants PC 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Providence Hospital, Southfield and Novi Hospital, Southfield, MI, CCN 230019
• Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Promoting interoperability

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cdickson1125200@direct.hfhs.org

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.

• Ear Nose and Throat Consultants PC

  • Specialist
  • Southfield, MI
  • NPI 1053484048

  MI

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health Providence Hospital

  • General Acute Care Hospital
  • Novi, MI
  • NPI 1144210253

  Hospital

  Care Compare affiliation
• Henry Ford Health St. John Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331596800000",
    "number": "1770560427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29201 TELEGRAPH RD",
            "address_2": "SUITE 500",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341331",
            "telephone_number": "248-569-5985",
            "fax_number": "248-569-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29201 TELEGRAPH RD",
            "address_2": "SUITE 500",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341331",
            "telephone_number": "248-569-5985",
            "fax_number": "248-569-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "CLARK",
        "middle_name": "BART",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2012-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": "CD046491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3211330",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael P Diamond, MD
• Diane I Hines DDS PC
• Alison Dib, LLMSW
• Brandon David Dick
• Dionne Serena Dickerson, M.D.
• Daniel Walter Didocha, D.O.
• Charlene Diehl
• Joycelyn Michelle Dier
• Kristy Diethrich
• Joanne Ruth Dietz, NP

• All providers in Southfield, MI
• Otolaryngology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; 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.
• 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.