Individual provider Active NPI

Douglas R. Fredrick, MD

  • Pediatric Ophthalmology and Strabismus Specialist Physician
  • Daly City, CA
National Provider Identifier
1053366633
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Ophthalmology and Strabismus Specialist PhysicianTaxonomy code 207WX0110X
License
A43821 Issued in CA
Practice address
395 Hickey Blvd
Daly City, CA 94015-2770
Phone
(650) 742-2000
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Ophthalmology and Strabismus Specialist Physician 207WX0110X A43821 CA Primary

Addresses

Primary practice location

395 Hickey Blvd
Daly City, CA 94015-2770

Mailing address

1800 Harrison St FL 7
Oakland, CA 94612-3466
Phone (510) 625-6262

Other identifiers 1

IdentifierTypeStateIssuer
00A438210MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070823000993 CA Practitioner - Ophthalmology 0042227274 Reassigns benefits to 2 organizations
I20180829002687 NY Practitioner - Ophthalmology 0042227274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Baylor College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17 E 102ND St 8TH FL
Ophthalmology Department of Mount
New York, NY 10029-5204
Phone 212241811848118

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A43821CAMDPediatric Ophthalmology and Strabismus Specialist Physician Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of California SFGH Medical Group Current Accepting new patients
University of California SFGH Medical Group Ophthalmology CurrentSince Nov 1, 2022 Accepting new patients
University of California SFGH Medical Group CurrentSince Nov 1, 2022 Accepting new patients
Permanente Medical Group, Inc CurrentSince Aug 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai Ophthalmology CurrentSince Sep 5, 2018 Accepting new patients
Icahn School of Medicine at Mount Sinai Ophthalmology CurrentSince Sep 5, 2018 Accepting new patients
Permanente Medical Group Inc Ophthalmology Current Accepting new patients
Permanente Medical Group Inc Ophthalmology CurrentSince Aug 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Stanford Health Care Past Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

395 Hickey Blvd
Daly City, CA 94015
Phone (650) 301-5800

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

1800 Harrison St
Fl 7
Oakland, CA 94612

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

1001 Potrero Ave
San Francisco, CA 94110
Phone (415) 206-2305

1635 Divisadero St
Ste 625
San Francisco, CA 94115
Phone (415) 476-1977

1001 Potrero Ave
Rm 3A
San Francisco, CA 94110
Phone (415) 206-4632

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834

310 E 14th St
New York, NY 10003
Phone (212) 979-4000

218 2nd Ave
New York, NY 10003
Phone (212) 979-4000

150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119

77 Worth St
Frnt 1
New York, NY 10013
Phone (212) 257-6900

17 E 102nd St
Fl 8
New York, NY 10029
Phone (212) 241-0939

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Organizations & group practices 10

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1053366633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HARRISON ST FL 7",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946123466",
            "telephone_number": "510-625-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 HICKEY BLVD",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152770",
            "telephone_number": "650-742-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICK",
        "first_name": "DOUGLAS",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0110X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist",
            "state": "CA",
            "license": "A43821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A438210",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "395 Hickey Blvd",
            "city": "Daly City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940152770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Daly City, CA

Sources for this page

Verify at the official NPI Registry.