Charles E Fredericks, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

28703 Issued in TN

Practice address

2000 Church St
Nashville, TN 37236-0001

Phone

(800) 251-2014

Fax

(615) 284-3854

NPI assigned

Jun 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Middle Tennessee Emergency Physicians PC

  • Emergency Medicine Physician
  • Nashville, TN
  • NPI 1194758979

  Emergency Medicine, TN

  Medicare reassignment NPD

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276128000000",
    "number": "1104861624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 VANTAGE WAY",
            "address_2": "SUITE B240",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372281515",
            "telephone_number": "615-329-4020",
            "fax_number": "615-327-4403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 CHURCH ST",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372360001",
            "telephone_number": "800-251-2014",
            "fax_number": "615-284-3854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "CHARLES",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2010-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "28703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "3062222",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STONES RIVER IPA",
            "identifier": "3110235",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY MEDICAID",
            "identifier": "64028434",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3816000",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fred R Shanks O.D., L.L.C.
• Fred R Shanks, O.D., LLC
• Katherine Collier Frederick-Dyer
• Candice Frederick, MD
• Chelsea Frederick
• Harold Edwin Fredericks, D.D.S., M.S.
• Tessa Fredericksen
• Free Method Nutrition, LLC
• Harrison Xuyen Free
• Kathryn Free, D.O.

• All providers in Nashville, TN
• Emergency Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.