SANDRA DEE DICKERSON (MD) – Surgery Physician, NPI 1912964107

SANDRA DEE DICKERSON (MD) is a healthcare provider. based in Irving, Texas. specializing in Surgery Physician. They hold the professional credentials MD. They hold a License No. J7469 (TX). The NPI Number for SANDRA DEE DICKERSON (MD) is 1912964107

Main info

Female
Sole Proprietor
43 Years Of Experience
Accepts Medicare Assignment
Name
SANDRA DEE DICKERSON (MD)
NPI
1912964107
Phone
(972) 579-5222
Address
400 W INTERSTATE HWY 635 STE 130
Enumeration Date
1 May 2006
Last Update Date
2 July 2020

Doctor Profile

Medical School Name
UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Secondary Phone
9725795224
Graduation Year
1983 (43 years ago)
PAC ID
8820152929
Group Practice PAC ID
6103842083
Professional Enrollment ID
I20090205000044
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience74
Completeness75
Years active:20State licenses:1Digital endpointsOther names

Provider Addresses for SANDRA DEE DICKERSON (MD)

  • 400 W INTERSTATE HWY 635 STE 130

    IRVING, TX 750633700

    Phone: (972) 579-5222

    Fax: (972) 579-3900

    Type: Location

  • PO BOX 224702

    DALLAS, TX 752224702

    Phone: (972) 579-5222

    Fax: (972) 579-3900

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2009-02-05

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20090205000044IGeneral SurgeryTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 75063)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6103842083View full group profile
NameSpecialtyState
-TX

Reviews

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Frequently asked questions

Where can patients find SANDRA DEE DICKERSON (MD)'s NPI?
You can confirm SANDRA DEE DICKERSON (MD) with NPI 1912964107; it appears in the national provider directory.
Does this profile mean SANDRA DEE DICKERSON (MD) is currently active?
Yes — SANDRA DEE DICKERSON (MD) appears active in the national provider directory.
What kind of provider is SANDRA DEE DICKERSON (MD)?
The page reflects Surgery Physician for SANDRA DEE DICKERSON (MD). Clinical services aligned with this taxonomy classification.
What location shows for SANDRA DEE DICKERSON (MD)?
We surface Irving, Texas for SANDRA DEE DICKERSON (MD) based on available NPPES addresses.
What if Irving, Texas seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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