Staci E Dixon, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2008002406 Issued in MO

Practice address

2120 W Kearney St
Springfield, MO 65803-1653

Phone

(417) 869-6191

Fax

(417) 869-4131

NPI assigned

Jul 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Ohio University, College of Osteopathic Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Southern Missouri Ambulatory Services LLCGroup PAC ID 5193089621, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Mercy Southern Missouri Ambulatory Services LLC

  • Urgent Care Clinic/Center
  • Springfield, MO
  • NPI 1871094052

  MO

  Medicare reassignment Care Compare group NPD
• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Springfield, MO
  • NPI 1245277631

  Family Medicine, MO

  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  • Rural Health Clinic/Center
  • Willow Springs, MO
  • NPI 1972771657

  Family Medicine, MO

  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Hollister, MO
  • NPI 1053350454

  Family Medicine

  NPD
• Dennis J. Pierson, M.D., Inc.

  • Family Medicine Physician
  • Lima, OH
  • NPI 1013953942

  Family Medicine

  NPD (past)
• Lincoln County Hospital

  • Critical Access Hospital
  • Lincoln, KS
  • NPI 1942265327
  NPD (past)
• RC Miller MD., LLC

  • Internal Medicine Physician
  • Bowling Green, OH
  • NPI 1972697795
  NPD (past)
• Riverwood Emergency Services Inc.

  • Emergency Medicine Physician
  • Perrysburg, OH
  • NPI 1104888536
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1962436840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505164",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631505164",
            "telephone_number": "417-829-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 W KEARNEY ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658031653",
            "telephone_number": "417-869-6191",
            "fax_number": "417-869-4131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIXON",
        "first_name": "STACI",
        "middle_name": "E",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2008002406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE WEST",
            "identifier": "431560263",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962436840",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2268997",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathy A Divine
• Linda Marie Divine
• Tarrah Divine, FNP
• Anthony R Divito, MD
• Patricia Mary Dix, M.D.
• DLK Medicine LLC
• Rhonda Sue Dlouhy
• Dennis P. Dobard Jr., M.D.
• Derylin Zoe Dobyns, OTR
• Ervin W Dock, BC-HIS

• Family Medicine Physician in Springfield, MO
• Providers in Springfield, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.