NPIMap

Individual provider Active NPI

John Caleb Dickson, MD

  • Family Medicine Physician
  • Conway, AR
National Provider Identifier
1902292246
Registry record updated Aug 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-10417 Issued in AR
Practice address
2425 Dave Ward Dr Ste 401
Conway, AR 72034
Phone
(870) 972-0063
NPI assigned
Apr 14, 2015
Last updated
Aug 2, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X AR
Family Medicine Physician 207Q00000X E-10417 AR Primary

Addresses

Primary practice location

2425 Dave Ward Dr Ste 401
Conway, AR 72034

Mailing address

2425 Dave Ward Dr Ste 401
Conway, AR 72034-8681
Phone (501) 329-3824

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
I20180525001075 AR Practitioner - Family Practice 9436465838 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bowlin-Cummins PAGroup PAC ID 5698725745, 8 clinicians

Practice addresses (Care Compare)

2425 Dave Ward Dr
Suite 401
Conway, AR 72034-8681
Phone (501) 329-3824

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.22 of 100Reported as group
Quality
93.45
Improvement activities
40
Cost
72.81

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bowlin-Cummins PA Family Medicine CurrentSince Jun 1, 2018 Accepting new patients

Locations

2425 Dave Ward Dr
Ste 401
Conway, AR 72034
Phone (501) 329-3824

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Heritage Living CenterConway, AR, CCN 045308 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 19, 2024
Aug 19, 2024
Banister Lieblong ClinicConway, AR, CCN 043853 Rural health clinic 5% Or Greater Direct Ownership Interest (16.66%) Oct 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Bowlin-Cummins PA

    dba Banister-Lieblong Clinic

    • Rural Health Clinic/Center
    • Conway, AR
    • NPI 1861455057

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • HLNC, Inc

    dba Heritage Living Center

    • Skilled Nursing Facility
    • Conway, AR
    • NPI 1659662229

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

Organizations & group practices 1

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533168000000",
    "number": "1902292246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 DAVE WARD DR STE 401",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348681",
            "telephone_number": "501-329-3824",
            "fax_number": "501-327-2957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 DAVE WARD DR STE 401",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "870-972-0063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "JOHN",
        "middle_name": "CALEB",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-14",
        "last_updated": "2018-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AR",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-10417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.