Gary A. Frederick, M.D.
Individual provider Active NPI Family Medicine Physician · Shattuck, OK
NPI 1194723213 · NPPES record last updated Oct 21, 2009
Key facts
- NPI
- 1194723213
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 15799 (OK)
- Practice address
- 905 S Main St
Shattuck, OK 73858-9205 - Phone
- (580) 938-2551
- Fax
- (580) 938-2118
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Louisiana State University School of Medicine in New Orleans, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hemphill County Hospital District
Practice addresses (Care Compare)
1010 S 4TH St
Canadian, TX 79014-3315
Phone (806) 323-8882
1020 S 4TH St
Canadian, TX 79014-3315
Phone (806) 323-6422
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170905000373 | TX | Practitioner - Family Practice | 4880614692 |
Reassigns benefits to 1 organization Practice locations: Canadian, TX |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hemphill County Hospital District | Current |
Accepting new patients | |
| Newman Physicians' Group, Inc. | Family Medicine | Current |
Accepting new patients |
| Cancer Center of Kansas, P.a. | Past | Accepting new patients |
Locations
416 S Main St
Shattuck, OK 73858
Phone (405) 938-2551
905 S Main St
Shattuck, OK 73858
Phone (580) 938-2551
1020 S 4th St
Canadian, TX 79014
Phone (806) 323-6422
1010 S 4th St
Canadian, TX 79014
Phone (806) 323-8882
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FEDDBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 15799 | OK | Yes |
Addresses
Primary practice location
905 S Main St
Shattuck, OK 73858-9205
Mailing address
905 S Main St
Shattuck, OK 73858-9205
Phone (580) 938-2551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100652050B | Medicaid | OK |
Other providers in Shattuck, OK
- Lorrie Corbin
- John Rodney Cully
- Ellis County EMS
- Michael W. Flaherty
- Foundation Health & Wellness Institute PC
- HCC of Shattuck, LLC
- John David Herber
- Jennifer Hix
- Kristen a Burris, D.D.S. L.L.C.
- Gary Willis Mitchell
All providers in Shattuck, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.