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JACOB EDWARD DICKERSON DNAP
NPI 1013659960
Nurse Anesthetist, Certified Registered in Tahlequah, OK

Active since April 11, 2022
78.75/100
CMS Quality Rating
100 S BLISS AVE, TAHLEQUAH, OK 74464(918) 458-3100 Get Directions Write a Review

NPPES record last updated: July 10, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 10, 2022, Apr 11, 2022 (2 updates tracked since 2022).

About Jacob Edward Dickerson Dnap NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACOB EDWARD DICKERSON DNAP (NPI 1013659960) is an individual nurse anesthetist, certified registered in Tahlequah, Oklahoma, licensed in Oklahoma (208980) and active in the NPI registry since April 2022. He maintains a secondary practice location in Springfield.

NPPES Registry Identity

NPI1013659960
Entity TypeIndividualMale
Primary Taxonomy367500000X
Provider Legal NameJACOB EDWARD DICKERSONCredential: DNAP
Location Address100 S BLISS AVETahlequah, OK 74464-2512
Mailing Address21781 E 785 RdWelling, OK 74471-2035 · (918) 457-6922
Phone(918) 458-3100
Sole ProprietorYes
Enumeration DateApril 11, 2022
Last NPPES UpdateJuly 10, 20222 updates tracked since enumeration
NPPES CertifiedJuly 10, 2022
✔ NPI 1013659960 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
License✔ Licensed in OK · 208980
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
100 S BLISS AVE, Tahlequah, OK 74464
Open in Google Maps ↗

Secondary Practice Location 1

Location 1901 S National AveSpringfield, MO 65897-0001 · Phone (417) 836-5000

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacob Edward Dickerson Dnap is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Jacob Dickerson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Cherokee Nation
0.3 mi
General Acute Care Hospital
19780 E. ROSS STREET
Tahlequah, OK 74464
  • Reassigned Medicare billing, Texas enrollment
  • 1,047 clinicians in this Medicare group
NPI 1275799645 (539) 355-1000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Anesthesia for other procedure on large bowel using an endoscope 00811
Anesthesia for an endoscopic procedure on the large bowel ensures comfort and relaxation during the procedure. You'll be given medication to make you drowsy or asleep, eliminating any discomfort. The medication can be administered through a vein or inhaled.
25 services25 patients
Anesthesia for procedure on small and large bowel using an endoscope 00813
Anesthesia for an endoscopic procedure on the small and large bowel ensures comfort and relaxation during the procedure. It involves administering medicine to help you sleep or feel drowsy. This allows the doctor to examine your bowels without causing you discomfort or pain.
11 services11 patients

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

78.75/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality61.59
Promoting Interoperability98
Improvement Activities40
Cost65.11

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PATRICK WAYNE SHARP DO
Emergency Medicine
100 S BLISS AVE
TAHLEQUAH, OK 74464
Cherokee County (189) 458-3100
HASTINGS INDIAN MEDICAL CENTER
General Acute Care Hospital (Rural)
100 S BLISS AVE
TAHLEQUAH, OK 74464
Cherokee County (918) 458-3100
DR. ADAM K RICHARDS DPT
Physical Therapist
100 S BLISS AVE
TAHLEQUAH, OK 74464
Cherokee County (918) 458-3491
DR. BARINDER PAUL BASSI DPM
Podiatrist
100 S BLISS AVE
TAHLEQUAH, OK 74464
Cherokee County (918) 207-3780
DR. STEVEN RAY SCOTT PHARMD
Pharmacist (Pharmacotherapy)
100 S BLISS AVE
TAHLEQUAH, OK 74464
Cherokee County (918) 458-3100
MRS. CHERYL DELORES TARVER CNM
Advanced Practice Midwife
100 S BLISS AVE
TAHLEQUAH, OK 74464
Cherokee County (918) 458-3343
DR. GERALD RAY BROWN JR. PHARMD
Pharmacist
100 S BLISS AVE
TAHLEQUAH, OK 74464
Cherokee County (918) 458-3207
SYLVIA SOTO M.D.
Family Medicine
100 S BLISS AVE
TAHLEQUAH, OK 74464
Cherokee County (918) 458-3100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Dickerson's NPI number?

The NPI number for Jacob Dickerson is 1013659960. It was assigned to this individual provider in the NPPES registry on April 11, 2022.

Where is Jacob Dickerson located?

Jacob Dickerson practices at 100 S Bliss Ave, Tahlequah, OK 74464. The listed phone number is (918) 458-3100.

What is Jacob Dickerson's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Jacob Dickerson enrolled in Medicare?

Yes. Jacob Dickerson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jacob Dickerson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Dickerson reassigns Medicare benefits to Cherokee Nation (Tahlequah, OK). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacob Dickerson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jacob Dickerson was last updated on July 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.