NPIMap

Individual provider Active NPI

Jared A Dixon, MD

  • Family Medicine Physician
  • Benton, AR
National Provider Identifier
1780833707
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E7567 Issued in AR
Practice address
1304 Military Rd
Benton, AR 72015-2911
Phone
(501) 778-0934
Fax
(501) 778-1013
NPI assigned
Sep 15, 2008
Last updated
Feb 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E7567 AR Primary
Sports Medicine (Family Medicine) Physician 207QS0010X E7567 AR

Addresses

Primary practice location

1304 Military Rd
Benton, AR 72015-2911

Mailing address

1304 Military Rd
Benton, AR 72015-2911
Phone (501) 778-0934

Other identifiers 1

IdentifierTypeStateIssuer
194201001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120710000372 AR Practitioner - Family PracticePractitioner - Sports Medicine 5193905974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
University of Arkansas College of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prospective Health LTDGroup PAC ID 1456445402, 9 clinicians

Practice addresses (Care Compare)

1304 Military Rd
Benton, AR 72015-2911
Phone (501) 778-0934

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions21
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E7567ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospective Health LTD Family Medicine CurrentSince Jul 16, 2012 Accepting new patients
Neuroscience Associates PA Past Accepting new patients
Bonner Emergency Medicine Associates PA Past Accepting new patients

Locations

1304 Military Rd
Benton, AR 72015
Phone (501) 778-0934

Interoperability endpoints

  • Direct secure messaging: jareddixon-mmfpas@direct.medalliesmail.com

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1221436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1780833707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 MILITARY RD",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720152911",
            "telephone_number": "501-778-0934",
            "fax_number": "501-778-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 MILITARY RD",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720152911",
            "telephone_number": "501-778-0934",
            "fax_number": "501-778-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIXON",
        "first_name": "JARED",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-15",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E7567",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "AR",
            "license": "E7567",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194201001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

Verify at the official NPI Registry.