NPIMap

Individual provider Active NPI

Peter Daniel Fredericks, M.D.

  • Orthopaedic Surgery Physician
  • Colorado Springs, CO
National Provider Identifier
1003010919
Registry record updated May 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
FF3091573 Issued in CO
Practice address
175 S Union Blvd Ste 300
Colorado Springs, CO 80910-3126
Phone
(719) 365-1950
Fax
(719) 365-1951
NPI assigned
Jun 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X FF3091573 CO Primary

Addresses

Primary practice location

175 S Union Blvd Ste 300
Colorado Springs, CO 80910-3126

Mailing address

175 S Union Blvd Ste 300
Colorado Springs, CO 80910-3126
Phone (719) 365-1950

Other identifiers 1

IdentifierTypeStateIssuer
54988764MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131009002052 CO Practitioner - Orthopedic Surgery 4183871882 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Arizona College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1400 E Boulder
Suite 2410 Pre Procedure Memorial
Colorado Springs, CO 80909-5533
Phone (719) 365-6525

1400 E Boulder St
Colorado Springs, CO 80909-5533

175 S Union Blvd
Colorado Springs, CO 80910-3147

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022
  • Uchealth Grandview Hospital Hospital, Colorado Springs, CO, CCN 060130

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Orthopaedic Surgery Current Accepting new patients
Uch-MHS Past Accepting new patients
Poudre Valley Health Care,Inc Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

175 S Union Blvd
Ste 310
Colorado Springs, CO 80910
Phone (719) 365-6363

175 S Union Blvd
Ste 300
Colorado Springs, CO 80910
Phone (719) 365-6363

4190 E Woodmen Rd
Ste 100
Colorado Springs, CO 80920
Phone (630) 364-4851

3843 Rio Vista Dr
Ste 1200
Colorado Springs, CO 80917

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

9320 Grand Cordera Pkwy
Ste 100
Colorado Springs, CO 80924
Phone (719) 282-6337

175 S Union Blvd
Ste 125
Colorado Springs, CO 80910

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462492800000",
    "number": "1003010919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 S UNION BLVD STE 300",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809103126",
            "telephone_number": "719-365-1950",
            "fax_number": "719-365-1951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 S UNION BLVD STE 300",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809103126",
            "telephone_number": "719-365-1950",
            "fax_number": "719-365-1951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "PETER",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-13",
        "last_updated": "2016-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CO",
            "license": "FF3091573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54988764",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.