NPIMap

Individual provider Active NPI

William John Dickerson II, MD

  • Gastroenterology Physician
  • Plantation, FL
National Provider Identifier
1861448607
Registry record updated Feb 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
ME64924 Issued in FL
Practice address
4302 W Broward Blvd
Suite 200
Plantation, FL 33317-3780
Phone
(954) 771-3433
Fax
(954) 771-9911
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X ME64924 FL Primary

Addresses

Primary practice location

4302 W Broward Blvd
Suite 200
Plantation, FL 33317-3780

Mailing address

1 Edward St
Canton, MA 02021-2303
Phone (781) 828-3533

Other identifiers 2

IdentifierTypeStateIssuer
2719029 00MedicaidFL
52084OtherFLBLUE CROSS & BLUE SHIELD

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
I20041208000834 FL Practitioner - GastroenterologyPractitioner - Internal Medicine 2769448075 Practice locations: Tamarac, FL; Deerfield Beach, FL; Plantation, FL; Oakland Park, FL; Margate, FL; Ft Lauderdale, FL; Coral Springs, FL; Fort Lauderdale, FL

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Nebraska College of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1050 NE 45TH St
Oakland Park, FL 33334-3812
Phone (954) 771-3433

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux66

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Lauderdale Surgical Specialists P a Past Accepting new patients
Eastside Hospitalists Inc Past Accepting new patients
South Florida Acute Care, LLC Past Accepting new patients

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266451200000",
    "number": "1861448607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EDWARD ST",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020212303",
            "telephone_number": "781-828-3533",
            "fax_number": "781-828-2471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4302 W BROWARD BLVD",
            "address_2": "SUITE 200",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333173780",
            "telephone_number": "954-771-3433",
            "fax_number": "954-771-9911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "WILLIAM",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2010-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME64924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2719029 00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "52084",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

Verify at the official NPI Registry.