JORDAN DANIELLE DICKERSON NP
NPI 1093608515
Nurse Practitioner in Tyler, TX
About Jordan Danielle Dickerson Np NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JORDAN DANIELLE DICKERSON NP (NPI 1093608515) is an individual nurse practitioner in Tyler, Texas, licensed in Texas (1204964) and active in the NPI registry since June 2025. She is enrolled in Medicare PECOS, is affiliated with Ut Health East Texas Tyler Regional Hospital, and is a graduate of Other (2024).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jordan Danielle Dickerson Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jordan Dickerson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Tyler, TX 75701
- Reassigned Medicare billing, Texas enrollment
- 636 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare 5
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Ut Health East Texas Tyler Regional Hospital
Acute Care Hospitals · Tyler, TXChristus Mother Frances Hospital
Acute Care Hospitals · Tyler, TXUt Health East Texas Jacksonville Hospital
Acute Care Hospitals · Jacksonville, TXUt Health East Texas Athens Hospital
Acute Care Hospitals · Athens, TXUt Health East Texas Henderson Hospital
Acute Care Hospitals · Henderson, TXPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 75701 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
TYLER, TX 75701
TYLER, TX 75701
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 Jordan Dickerson's NPI number?
The NPI number for Jordan Dickerson is 1093608515. It was assigned to this individual provider in the NPPES registry on June 2, 2025.
Where is Jordan Dickerson located?
Jordan Dickerson practices at 912 S Fleishel Ave, Tyler, TX 75701. The listed phone number is (903) 592-6901.
What is Jordan Dickerson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.
Is Jordan Dickerson enrolled in Medicare?
Yes. Jordan Dickerson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jordan Dickerson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jordan Dickerson reassigns Medicare benefits to Etmc Physician Group Inc. (Tyler, TX). 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 Jordan Dickerson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jordan Dickerson accept?
Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 2 other insurers list Jordan Dickerson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Jordan Dickerson affiliated with any hospitals?
According to CMS data, Jordan Dickerson is affiliated with Ut Health East Texas Tyler Regional Hospital, Christus Mother Frances Hospital, Ut Health East Texas Jacksonville Hospital, Ut Health East Texas Athens Hospital and Ut Health East Texas Henderson Hospital.
When was this NPI record last updated?
The NPPES record for Jordan Dickerson was last updated on July 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.
# Jordan Danielle Dickerson, NP · NPI 1093608515
Nurse Practitioner physician in Tyler, Texas. Individual provider, active in the CMS NPPES registry since June 2, 2025.
## Identity
- **NPI:** 1093608515 (Entity type: Individual)
- **Enumerated:** June 2, 2025
- **Primary specialty:** Nurse Practitioner · taxonomy 363L00000X
- **State license:** 1204964 (Texas)
- **Sole proprietor:** No
## Practice location
- **Address:** 912 S FLEISHEL AVE, Tyler, TX 75701-2018
- **Phone:** (903) 592-6901
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Etmc Physician Group Inc. (NPI 1609382662, Tyler, TX), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** July 15, 2025
---
Source: [NPI Profile](https://npiprofile.com/npi/1093608515) · Data from the CMS NPPES public registry.