NPIMap

Individual provider Active NPI

Samuel Barnabas Dickmann, MD

  • Family Medicine Physician
  • Bradenton, FL
National Provider Identifier
1831517317
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME129516 Issued in FL
Practice address
5123 4TH Avenue Cir E
Bradenton, FL 34208-5620
Phone
(941) 744-5510
Fax
(941) 744-5166
NPI assigned
Apr 2, 2014
Last updated
Dec 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME129516 FL Primary

Addresses

Primary practice location

5123 4TH Avenue Cir E
Bradenton, FL 34208-5620

Mailing address

5123 4TH Avenue Cir E
Bradenton, FL 34208-5620
Phone (941) 744-5510

Other identifiers 1

IdentifierTypeStateIssuer
020510500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20170627000631 FL Practitioner - Family Practice 0840418620 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Florida College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cooper Family Medical PLLCGroup PAC ID 9931171782, 19 clinicians
H2 Rehabilitation Services of Florida LLCGroup PAC ID 3971411851, shared by 10 NPIs, 257 clinicians

Practice addresses (Care Compare)

5123 4TH Ave Cir E
Bradenton, FL 34208-5620
Phone (941) 744-5510

8220 Natures Way
Apt 201
Lakewood Ranch, FL 34202-4208
Phone (800) 699-9395

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions16
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME129516FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc Family Medicine CurrentSince Jul 1, 2017 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jul 1, 2017 Accepting new patients
Cooper Family Medical PLLC Family Medicine CurrentSince Jan 1, 2024 Accepting new patients
Florida Clinical Practice Association Inc Family Medicine PastSince Nov 1, 2022 Accepting new patients

Locations

5123 4th Avenue Cir E
Bradenton, FL 34208
Phone (941) 744-5510

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

13611 NW 1st Ln
Ste 200
Newberry, FL 32669
Phone (352) 265-8670

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26999/brand/2/csg/1/fhir/r4
  • Direct secure messaging: samuel.dickmann.md.1@26999.direct.athenahealth.com

Organizations & group practices 4

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": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1831517317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5123 4TH AVENUE CIR E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085620",
            "telephone_number": "941-744-5510",
            "fax_number": "941-744-5166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5123 4TH AVENUE CIR E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085620",
            "telephone_number": "941-744-5510",
            "fax_number": "941-744-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKMANN",
        "first_name": "SAMUEL",
        "middle_name": "BARNABAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME129516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020510500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.