NPIMap

Organization Active NPI

Meadowcrest Family Practice PA

  • Family Medicine Physician
  • Crystal River, FL
National Provider Identifier
1831233816
Registry record updated Jan 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0958010001 Issued in FL
Legal business name
MEADOWCREST FAMILY PRACTICE PA
Practice address
5915 W Gulf to Lake Hwy
Crystal River, FL 34429-7565
Phone
(352) 795-0644
Fax
(352) 795-5950
NPI assigned
Feb 16, 2007
Last updated
Jan 7, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2009

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

Authorized official

Name
Dr. Jimmy C Dickert, D.O.
Title
Direct Owner
Phone
(352) 795-0644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0958010001 FL Primary

Addresses

Primary practice location

5915 W Gulf to Lake Hwy
Crystal River, FL 34429-7565

Mailing address

5915 W Gulf to Lake Hwy
Crystal River, FL 34429-7565
Phone (352) 795-0644

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231286400000",
    "number": "1831233816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344297565",
            "telephone_number": "352-795-0644",
            "fax_number": "352-795-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344297565",
            "telephone_number": "352-795-0644",
            "fax_number": "352-795-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOWCREST FAMILY PRACTICE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2009-01-07",
        "status": "A",
        "authorized_official_last_name": "DICKERT",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECT OWNER",
        "authorized_official_telephone_number": "352-795-0644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "0958010001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal River, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.