John Caleb Dickson, MD
Individual provider Active NPI Family Medicine Physician · Conway, AR
NPI 1902292246 · NPPES record last updated Aug 2, 2018
Key facts
- NPI
- 1902292246
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E-10417 (AR)
- Practice address
- 2425 Dave Ward Dr Ste 401
Conway, AR 72034 - Phone
- (870) 972-0063
- NPI assigned
- Apr 14, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 13
Owned or controlled facilities with NPI records 2
Medicare Care Compare profile
- 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 PA
Practice addresses (Care Compare)
2425 Dave Ward Dr
Suite 401
Conway, AR 72034-8681
Phone (501) 329-3824
Hospital & facility affiliations
- Conway Regional Homecare SVCS
- Elite Home Health
- Baptist Health Home Health-LR
- Centerwell Home Health
- Conway Regional Medical Center, Inc
- Baptist Health Medical Center- Conway
- Baptist Health Medical Center-Little Rock
- Heritage Living Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.22 of 100
- Quality
- 93.45
- Improvement activities
- 40
- Cost
- 72.81
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Heritage Living Center |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Aug 19, 2024 Aug 19, 2024 |
| Banister Lieblong Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (16.66%) | Oct 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180525001075 | AR | Practitioner - Family Practice | 9436465838 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-10417 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bowlin-Cummins PA | Family Medicine | Current |
Accepting new patients |
Locations
2425 Dave Ward Dr
Ste 401
Conway, AR 72034
Phone (501) 329-3824
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | AR | ||
| Family Medicine Physician | 207Q00000X | E-10417 | AR | Yes |
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
Other providers in Conway, AR
- Diamond State Personal Care, Inc.
- Dawn Nichole Dickerson
- Heather Elizabeth Dickerson
- Shalay Dickerson
- Joshua Dickinson
- McKinsey Dickson
- Kim Dielmann
- Alexis Paige Dill
- Laura J Dill
- Brandi Dingler
All providers in Conway, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.