Mary Evans Dickerson, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

125082094 Issued in IL

Practice address

751 N Rutledge St Ste 2300
Springfield, IL 62702-4968

Phone

(217) 545-8000

NPI assigned

May 29, 2023

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1685318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1780377697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19644",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST STE 2300",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024968",
            "telephone_number": "217-545-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "MARY",
        "middle_name": "EVANS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-29",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "125082094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• DHS-McFarland MHC-Kennedy Hall
• Kelly J Dial, LCSW
• Shelby Lynn Dial, PHARMD, BCPS
• Michelle Diatte
• Kyle William Dickerman, RBT
• John Charles Dickinson, CNA
• Isabella Dickson
• Sarah M Dietrich-Yockey, M.D.
• Leslie Dignan-Moore, M.D.
• Lila M. Dilbaitis, LCSW

• All providers in Springfield, IL
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.