Active NPI
Leroy E Fredericks, M.D.
- Hematology & Oncology Physician
- Lake Charles, LA
National Provider Identifier
1043335755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- MD10005R
- Practice address
- 2770 3Rd Ave Ste 210
Lake Charles, LA 70601-0404 - Phone
- (337) 494-6768
- Fax
- (337) 494-6792
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | MD10005R | LA | Primary |
Addresses
Primary practice location
2770 3Rd Ave Ste 210
Lake Charles, LA 70601-0404
Mailing address
PO Box 122579
Dept 2579
Dallas, TX 75312-2579
Phone (337) 494-2921
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1491217 | Medicaid | LA | |
| MD.10005R | Other | LA | STATE MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090520000497 | LA | Practitioner - Medical Oncology | 0749339869 |
Care Compare profile
Medicare Care Compare- Specialty
- Medical Oncology
- Education
- Louisiana State University School of Medicine in New Orleans, 1997
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Dallas, TX 75312
Hospital & facility affiliations
- Lake Charles Memorial Hospital
- Ochsner American Legion Hospital
- West Calcasieu Cameron Hospital
- Dequincy Memorial Hospital
- Beauregard Memorial Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD10005R | LA | MD | Hematology & Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Swlhs, Inc. | Hematology & Oncology | Current | Accepting new patients |
Locations
109 W 4th St
Deridder, LA 70634
Phone (337) 221-3004
2770 3rd Ave
Ste 350
Lake Charles, LA 70601
Phone (337) 494-2750
2770 3rd Ave
Ste 210
Lake Charles, LA 70601
Phone (337) 494-6768
619 S Huntington St
Sulphur, LA 70663
Phone (337) 494-3278
3924 Maplewood Dr
Sulphur, LA 70663
Phone (337) 494-6768
Organizations & group practices 1
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.
-
- Hematology & Oncology Physician
- Lake Charles, LA
- NPI 1164540175
Hospital & facility affiliations 13
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Sulphur, LA
- NPI 1083992382
-
- General Acute Care Hospital
- Sulphur, LA
- NPI 1093719932
-
- Multi-Specialty Clinic/Center
- Sulphur, LA
- NPI 1215560974
Hospital
-
- Otolaryngology/Facial Plastic Surgery Physician
- Sulphur, LA
- NPI 1366700387
Hospital
-
- Obstetrics & Gynecology Physician
- Sulphur, LA
- NPI 1619221348
Hospital
-
- Critical Access Hospital
- Dequincy, LA
- NPI 1902469653
-
- Rural Acute Care Hospital
- Deridder, LA
- NPI 1831193499
-
- General Acute Care Hospital
- Jennings, LA
- NPI 1184373268
-
- Gastroenterology Physician
- Lake Charles, LA
- NPI 1285351411
Hospital
-
- Rheumatology Physician
- Lake Charles, LA
- NPI 1659424075
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651017600000",
"number": "1043335755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 122579",
"address_2": "DEPT 2579",
"city": "DALLAS",
"state": "TX",
"postal_code": "753122579",
"telephone_number": "337-494-2921",
"fax_number": "337-494-6523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2770 3RD AVE STE 210",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706010404",
"telephone_number": "337-494-6768",
"fax_number": "337-494-6792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICKS",
"first_name": "LEROY",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2022-04-27",
"certification_date": "2022-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "LA",
"license": "MD10005R",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1491217",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MEDICAL LICENSE",
"identifier": "MD.10005R",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.