NPIMap

Individual provider Active NPI

Lance M Dicker, MD

  • Nephrology Physician
  • Salem, OR
National Provider Identifier
1902022817
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD27291 Issued in OR
Practice address
875 Oak St SE
Ste 5070
Salem, OR 97301-3975
Phone
(503) 561-8565
NPI assigned
Apr 18, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X MD27291 OR Primary

Addresses

Primary practice location

875 Oak St SE
Ste 5070
Salem, OR 97301-3975

Mailing address

875 Oak St SE Ste 5070
Salem, OR 97301-3975
Phone (503) 561-8565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20070705000188 OR Practitioner - NephrologyPractitioner - Internal Medicine 8820198849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
State University of New York Downstate Medical Center, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney Care Physicians LLCGroup PAC ID 0840283511, 11 clinicians

Practice addresses (Care Compare)

875 Oak St SE
Suite 5070
Salem, OR 97301-3998
Phone (503) 511-8565

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Care Physicians LLC Nephrology CurrentSince Jul 2, 2007 Accepting new patients
Salem Health Past Accepting new patients

Locations

550 Dietz Ave NE
Keizer, OR 97303
Phone (503) 393-0540

875 Oak St SE
Ste 5070
Salem, OR 97301
Phone (503) 561-8564

Organizations & group practices 2

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 6

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": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902022817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 OAK ST SE STE 5070",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013975",
            "telephone_number": "503-561-8565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 OAK ST SE",
            "address_2": "STE 5070",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013975",
            "telephone_number": "503-561-8565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKER",
        "first_name": "LANCE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OR",
            "license": "MD27291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.