Active NPI
Robert S Fredrick, M.D.
- Family Medicine Physician
- Toledo, OH
National Provider Identifier
1215933114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35055622
- Practice address
- 2051 W Central Ave
Toledo, OH 43606-3948 - Phone
- (419) 291-2051
- Fax
- (419) 479-6952
- NPI assigned
- Jun 24, 2005
- Last updated
- Sep 16, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35055622 | OH | Primary |
Addresses
Primary practice location
2051 W Central Ave
Toledo, OH 43606-3948
Mailing address
2051 W Central Ave
Toledo, OH 43606-3948
Phone (419) 291-2051
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000031391 | Other | OH | ANTHEM-WWK |
| 0690435 | Medicaid | OH | |
| 344428256 | Other | MI | PHCS |
| 000000185513 | Other | OH | ANTHEM-CHS |
| 9352225002 | Other | OH | CIGNA |
| 01514 | Other | OH | PARAMOUNT |
| 106250 | Other | OH | CARE CHOICES |
| 4243601 | Other | OH | AETNA |
| 30096 | Other | OH | NATIONWIDE |
| 3221935 | Medicaid | MI | |
| 01-04057 | Other | OH | UNITED |
| 01397 | Other | OH | PARAMOUNT |
| 3424240 | Medicaid | MI | |
| 6893 | Other | MI | HPM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379289600000",
"number": "1215933114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2051 W CENTRAL AVE",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436063948",
"telephone_number": "419-291-2051",
"fax_number": "419-479-6952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2051 W CENTRAL AVE",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436063948",
"telephone_number": "419-291-2051",
"fax_number": "419-479-6952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDRICK",
"first_name": "ROBERT",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-24",
"last_updated": "2013-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "35055622",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM-WWK",
"identifier": "000000031391",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0690435",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "344428256",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM-CHS",
"identifier": "000000185513",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "9352225002",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARAMOUNT",
"identifier": "01514",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICES",
"identifier": "106250",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4243601",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONWIDE",
"identifier": "30096",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3221935",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED",
"identifier": "01-04057",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARAMOUNT",
"identifier": "01397",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3424240",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPM",
"identifier": "6893",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.