Lydie-Danielle Frederic, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110010195 Issued in VA

Practice address

750 Brunswick Ave
Trenton, NJ 08638-4143

Phone

(609) 394-6000

NPI assigned

Nov 20, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Lydie-Dani Frederic Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

State University of New York Downstate Medical Center, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science, Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lydiedanielle.frederic@capitalhealth.cernerdirect.com
• Direct secure messaging: lydie-danielle.frederic.1@24989.direct.athenahealth.com

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.

• Sentara Medical Group

  • Family Medicine Physician
  • Norfolk, VA
  • NPI 1265485270
  Medicare reassignment Care Compare group NPD
• Capital Health Multispecialty Group

  • Surgery Physician
  • Trenton, NJ
  • NPI 1083072342
  Medicare reassignment
• Faster Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Morris Plains, NJ
  • NPI 1326291253
  Medicare reassignment

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

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1104160753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 SPEEDWELL AVE",
            "city": "MORRIS PLAINS",
            "state": "NJ",
            "postal_code": "079502315",
            "telephone_number": "862-242-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 BRUNSWICK AVE",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086384143",
            "telephone_number": "609-394-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Riverview Ave Ste 202A",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235101065",
            "country_code": "US",
            "telephone_number": "757-252-9140",
            "fax_number": "757-793-4149",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Speedwell Ave",
            "address_purpose": "LOCATION",
            "city": "Morris Plains",
            "state": "NJ",
            "postal_code": "079502315",
            "country_code": "US",
            "telephone_number": "862-242-8053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDERIC",
        "first_name": "LYDIE-DANIELLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-20",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016255",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00345300",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110010195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Lydiedanielle.Frederic@capitalhealth.cernerdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "750 Brunswick Ave",
            "city": "Trenton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "086384143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LYDIE-DANI",
            "last_name": "FREDERIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physician Assistant in Trenton, NJ
• Providers in Trenton, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.