Kim S Frederickson, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G79619 Issued in CA

Practice address

400 Professional Center Drive
Suite 414 Novato Dermatology Associates
Novato, CA 94947

Phone

(415) 892-0754

Fax

(415) 897-3204

NPI assigned

Nov 6, 2006

Last updated

Oct 10, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of California, Davis School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Novato Dermatology Associates a Medical CorporationGroup PAC ID 2466345467, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novato Community Hospital Hospital, Novato, CA, CCN 050131

Merit-based Incentive Payment System (MIPS)

Final score

95.71 of 100Reported as group

Quality

100

Improvement activities

40

Cost

85.7

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kfrederickson691446@direct.ochin.org

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

• Novato Dermatology Associates a Medical Corporation

  • Dermatology Physician
  • Novato, CA
  • NPI 1003960063
  Medicare reassignment Care Compare group Authorized official
• Marin General Hospital

  • General Acute Care Hospital
  • Greenbrae, CA
  • NPI 1396725677
  NPD (past)
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Novato, CA
  • NPI 1104059153
  NPD (past)

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

• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Novato, CA
  • NPI 1104059153
  Care Compare affiliation

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223596800000",
    "number": "1003995291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 PROFESSIONAL CENTER DRIVE",
            "address_2": "SUITE 414",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "94947",
            "telephone_number": "415-892-0754",
            "fax_number": "415-897-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 PROFESSIONAL CENTER DRIVE",
            "address_2": "SUITE 414 NOVATO DERMATOLOGY ASSOCIATES",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "94947",
            "telephone_number": "415-892-0754",
            "fax_number": "415-897-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKSON",
        "first_name": "KIM",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2008-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G79619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Fonarev, MS COUNSELING
• Margo Dwight Forbes, MFT
• Sarah Fox
• Andrew Frazier
• Nancy P. Frease, MFT
• Vincent John Freemantle, DDS
• Dana Buzon Freitas
• Maria Cristina Frias
• Grace Elizabeth Frost, CPCO
• Julie Hanlon Fujita, CAMTC

• Dermatology Physician in Novato, CA
• Providers in Novato, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.