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SHANE CHARLES DICKERSON M.D.
NPI 1740522341
Anesthesiology in Los Angeles, CA

Active since March 21, 2013PECOS EnrolledAccepts Medicare Assignment
1500 SAN PABLO ST FL 4, LOS ANGELES, CA 90033(323) 442-7400 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 21, 2022, Mar 17, 2018, Jun 19, 2017 (3 updates tracked since 2017).

About Shane Charles Dickerson M.d. NPPES

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

SHANE CHARLES DICKERSON M.D. (NPI 1740522341) is an individual anesthesiology provider in Los Angeles, California, licensed in California (A147680) and active in the NPI registry since March 2013. He is enrolled in Medicare PECOS, is affiliated with Clara Maass Medical Center, and maintains a secondary practice location in New York.

NPPES Registry Identity

NPI1740522341
Entity TypeIndividualMale
Primary Taxonomy207L00000X
Provider Legal NameSHANE CHARLES DICKERSONCredential: M.D.
Location Address1500 SAN PABLO ST FL 4Los Angeles, CA 90033-5313
Mailing AddressPo Box 31309Los Angeles, CA 90031-0309 · (323) 442-7400
Phone(323) 442-7400
Sole ProprietorNo
Medical School CMSColumbia University College Of Physicians And SurgeonsGraduated 2013
Enumeration DateMarch 21, 2013
Last NPPES UpdateJuly 21, 20223 updates tracked since enumeration
✔ NPI 1740522341 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAnesthesiologyAllopathic & Osteopathic Physicians
Taxonomy Code207L00000X
License✔ Licensed in CA · A147680
Definition
An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1500 SAN PABLO ST FL 4, Los Angeles, CA 90033
Open in Google Maps ↗

Secondary Practice Location 1

Location 1243 W 107th St Apt 4WNew York, NY 10025-3080 · Phone (609) 214-1518

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

Shane Charles Dickerson M.d. 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.

PECOS PAC ID3375810336
PECOS Enrollment IDI20210819002331
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Shane Dickerson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Usc Care Medical Group, Inc
Same address
General Practice
1520 SAN PABLO ST
Los Angeles, CA 90033
  • Reassigned Medicare billing, California enrollment
  • 2,445 clinicians in this Medicare group
NPI 1902846306 (323) 442-5955
Rwjbh Observation Associates LLC
2,433 mi
Emergency Medicine
94 OLD SHORT HILLS RD
Livingston, NJ 07039
  • Reassigned Medicare billing, New Jersey enrollment
  • 1,913 clinicians in this Medicare group
NPI 1760095806 (888) 724-7123

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 3

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.

Injection of local anesthetic for abdominal wall pain control on both sides using imaging guidance 64488
This procedure involves injecting a local anesthetic into the abdominal wall to manage pain. It's carried out on both sides of the abdomen using imaging guidance for precision. This helps numb the area, providing relief from discomfort.
22 services22 patients
Injection of local anesthetic for abdominal wall pain control on side using imaging guidance 64486
This procedure involves the use of a small needle to deliver pain-relieving medicine into the side of your abdomen. It's guided by real-time imaging to ensure precision. This helps to control pain in the abdominal wall area.
15 services15 patients
Insertion of artery tube for blood sampling or infusion through skin 36620
This procedure involves placing a small tube into an artery, usually in the wrist or elbow, to collect blood samples or administer medication. It's done under local anesthesia and is a common, safe practice.
14 services14 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Clara Maass Medical Center

Acute Care Hospitals · Belleville, NJ
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310009
LocationOne Clara Maass DriveBelleville, NJ 07109 · Essex County
Emergency services Birthing friendly

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.

OMAR DURRA MD
Anesthesiology
1500 SAN PABLO ST FL 4
LOS ANGELES, CA 90033
Los Angeles County (323) 442-7400
JOSEPH SOO KIM MD
Anesthesiology (Critical Care Medicine)
1500 SAN PABLO ST FL 4
LOS ANGELES, CA 90033
Los Angeles County (323) 442-7400
JONATHAN WU MD
Anesthesiology
1500 SAN PABLO ST FL 4
LOS ANGELES, CA 90033
Los Angeles County (323) 442-7400
DAVIT KOCHARYAN MD; MSC
Anesthesiology (Critical Care Medicine)
1500 SAN PABLO ST FL 4
LOS ANGELES, CA 90033
Los Angeles County (323) 442-7400
KHOA TRAN
Anesthesiology
1500 SAN PABLO ST FL 4
LOS ANGELES, CA 90033
Los Angeles County (323) 442-7400
DR. JOSHUA I SANTOS MD
Anesthesiology
1500 SAN PABLO ST FL 4
LOS ANGELES, CA 90033
Los Angeles County (323) 442-7400
DIVYA HARIHARAN DHARIA DO
Anesthesiology
1500 SAN PABLO ST FL 4
LOS ANGELES, CA 90033
Los Angeles County (323) 442-7400
SARIKA DARSHAN CRNA
Nurse Anesthetist, Certified Registered
1500 SAN PABLO ST FL 4
LOS ANGELES, CA 90033
Los Angeles County (323) 442-7400

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 Shane Dickerson's NPI number?

The NPI number for Shane Dickerson is 1740522341. It was assigned to this individual provider in the NPPES registry on March 21, 2013.

Where is Shane Dickerson located?

Shane Dickerson practices at 1500 San Pablo St Fl 4, Los Angeles, CA 90033. The listed phone number is (323) 442-7400.

What is Shane Dickerson's specialty?

The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.

Is Shane Dickerson enrolled in Medicare?

Yes. Shane 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 organizations bill Medicare for Shane Dickerson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shane Dickerson reassigns Medicare benefits to 2 organizations: Usc Care Medical Group, Inc (Los Angeles, CA) and Rwjbh Observation Associates LLC (Livingston, NJ). Each 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 Shane Dickerson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Shane Dickerson affiliated with any hospitals?

According to CMS data, Shane Dickerson is affiliated with Clara Maass Medical Center.

When was this NPI record last updated?

The NPPES record for Shane Dickerson was last updated on July 21, 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.