NPIMap

Individual provider Active NPI

David Jonathan Frederiks, MD

  • Hospitalist Physician
  • New London, CT
National Provider Identifier
1225048168
Registry record updated Jun 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
036811 Issued in CT
Practice address
365 Montauk Ave
Room 4.512
New London, CT 06320-4700
Phone
(860) 442-0711
Fax
(860) 444-5144
NPI assigned
Aug 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 036811 CT Primary

Addresses

Primary practice location

365 Montauk Ave
Room 4.512
New London, CT 06320-4700

Mailing address

365 Montauk Ave
Room 4.512
New London, CT 06320-4700
Phone (860) 442-0711

Other identifiers 1

IdentifierTypeStateIssuer
001368118MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20040430000779 CT Practitioner - Family Practice 6204823172 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rutgers New Jersey Medical School, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospital Medicine Associates LLCGroup PAC ID 9234156985, 208 clinicians

Practice addresses (Care Compare)

365 Montauk Ave
New London, CT 06320-4700
Phone (860) 442-0711

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lawrence and Memorial Hospital, Inc. CurrentSince Dec 11, 2003 Accepting new patients
Ipc Hospitalists of New England PC Hospitalist CurrentSince Nov 18, 2009 Accepting new patients
Lawrence and Memorial Hospital, Inc. Hospitalist CurrentSince Dec 11, 2003 Accepting new patients
Ipc Hospitalists of New England, P.C. Hospitalist CurrentSince Nov 18, 2009 Accepting new patients
Hospital Internists of New London, LLC Hospitalist Past Accepting new patients
Sound Medical Associates, PC Past Accepting new patients
Conncare Inc Past Accepting new patients
Community Health Center Inc Past Accepting new patients

Locations

365 Montauk Ave
Rm 4512
New London, CT 06320

365 Montauk Ave
Rm 4
New London, CT 06320

365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364

25 Wells St
Westerly, RI 02891
Phone (401) 348-3325

Interoperability endpoints

  • Direct secure messaging: dfredericks329669@direct.ynhh.org

Organizations & group practices 9

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.

Hospital & facility affiliations 6

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": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371168000000",
    "number": "1225048168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "address_2": "ROOM 4.512",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204700",
            "telephone_number": "860-442-0711",
            "fax_number": "860-444-5144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "address_2": "ROOM 4.512",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204700",
            "telephone_number": "860-442-0711",
            "fax_number": "860-444-5144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERIKS",
        "first_name": "DAVID",
        "middle_name": "JONATHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2013-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "036811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001368118",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.