NPIMap

Individual provider Active NPI

Larry J Dickinson, D.O.

  • Family Medicine Physician
  • Gallatin, MO
National Provider Identifier
1972583094
Registry record updated Nov 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R7052 Issued in MO
Practice address
100 E Johnson St
Gallatin, MO 64640-1338
Phone
(660) 663-2800
Fax
(660) 663-3707
NPI assigned
Jan 17, 2006
Last updated
Nov 20, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R7052 MO Primary

Addresses

Primary practice location

100 E Johnson St
Gallatin, MO 64640-1338

Mailing address

100 E Johnson St
PO Box 98
Gallatin, MO 64640-1338
Phone (660) 663-2800

Other identifiers 1

IdentifierTypeStateIssuer
240880708MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20100130000146 MO Practitioner - Family Practice 2264493543 Practice locations: Gallatin, MO

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

100 E Johnson St
Gallatin, MO 64640-1338
Phone (660) 663-2800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions34
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Osby Corp. Past Accepting new patients
Saint Lukes Hospital of Chillicothe PastSince Apr 30, 2003 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Daviess County Nursing and RehabilitationGallatin, MO, CCN 265729 Skilled nursing facility Operational/Managerial Control Jan 1, 1977

Owned or controlled facilities with NPI records 1

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

  • The Osby Corp.

    dba Daviess County Nursing & Rehab

    • Skilled Nursing Facility
    • Gallatin, MO
    • NPI 1043206378

    Operational/Managerial Control

    CMS ownership

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 12

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": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258675200000",
    "number": "1972583094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E JOHNSON ST",
            "address_2": "PO BOX 98",
            "city": "GALLATIN",
            "state": "MO",
            "postal_code": "646401338",
            "telephone_number": "660-663-2800",
            "fax_number": "660-663-3707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E JOHNSON ST",
            "city": "GALLATIN",
            "state": "MO",
            "postal_code": "646401338",
            "telephone_number": "660-663-2800",
            "fax_number": "660-663-3707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKINSON",
        "first_name": "LARRY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2009-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R7052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240880708",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallatin, MO

Sources for this page

Verify at the official NPI Registry.