Physician Compare National (NPI:1578579652)

HEALTHCARE PROVIDER: DIONNE SERENA DICKERSON M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1578579652
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587568431
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20031126000637
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DICKERSON
	Individual professional last name
Provider First Name	DIONNE
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	WRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	29255 NORTHWESTERN HWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	SOUTHFIELD
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	480345741
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230130
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BEAUMONT HOSPITAL, ROYAL OAK
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y