NPIMap

Individual provider Active NPI

Annette Frederick

  • Gerontology Nurse Practitioner
  • Bethlehem, PA
National Provider Identifier
1164931689
Registry record updated Oct 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
SP017937 Issued in PA
Practice address
153 Brodhead Rd
Bethlehem, PA 18017-8931
Phone
(484) 526-7035
NPI assigned
Sep 27, 2017
Last updated
Oct 3, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X TGRN035281 PA
Gerontology Nurse Practitioner 363LG0600X RN565313 PA
Gerontology Nurse Practitioner 363LG0600X SP017937 PA Primary

Addresses

Primary practice location

153 Brodhead Rd
Bethlehem, PA 18017-8931

Mailing address

801 Ostrum St
Bethlehem, PA 18015-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171108003334 PA Practitioner - Nurse Practitioner 1254697121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

153 Brodhead Rd
Bethlehem, PA 18017-8931
Phone (484) 526-7035

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN565313PAMDGerontology Nurse Practitioner
TGRN035281PAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Physician Group, Inc. CurrentSince Oct 16, 2017 Accepting new patients
St. Luke's Physician Group, Inc. Current Accepting new patients
St Luke's Physician Group Inc CurrentSince Oct 16, 2017 Accepting new patients
St. Luke's Physician Group, Inc. Past Accepting new patients

Locations

350 S Cedarbrook Rd
Allentown, PA 18104
Phone (610) 336-5696

421 Chew St
Allentown, PA 18102
Phone (610) 776-4500

535 N 17th St
Allentown, PA 18104
Phone (610) 432-4351

601 Saint John St
Allentown, PA 18103
Phone (610) 776-3130

1200 Spring St
Bethlehem, PA 18018
Phone (610) 865-5595

153 Brodhead Rd
Bethlehem, PA 18017
Phone (484) 526-3200

4005 Green Pond Rd
Bethlehem, PA 18020
Phone (484) 526-4035

4311 Easton Ave
Bethlehem, PA 18020
Phone (610) 954-3600

175 Newlins Rd W
Easton, PA 18040
Phone (484) 526-4035

2125 Fairview Ave
Easton, PA 18042
Phone (610) 258-2801

4098 Freemansburg Ave
Easton, PA 18045
Phone (610) 330-9030

4100 Freemansburg Ave
Easton, PA 18045
Phone (610) 330-9030

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

Organizations & group practices 4

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.

Hospital & facility affiliations 10

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": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506988800000",
    "number": "1164931689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 OSTRUM ST",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180151000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 BRODHEAD RD",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180178931",
            "telephone_number": "484-526-7035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "ANNETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2017-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "TGRN035281",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "RN565313",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP017937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethlehem, PA

Sources for this page

Verify at the official NPI Registry.