O'Ann Karin Fredstrom, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

5032A Issued in WY

Practice address

610 West Broadway
Suite L02
Jackson, WY 83001

Phone

(307) 734-8800

Fax

(307) 734-8900

NPI assigned

Nov 9, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2017 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Mental Health & Recovery Services of Jackson Hole

  • Case Manager/Care Coordinator
  • Jackson, WY
  • NPI 1548137508
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225108657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 15540",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83002",
            "telephone_number": "307-734-8800",
            "fax_number": "307-734-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 WEST BROADWAY",
            "address_2": "SUITE L02",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83001",
            "telephone_number": "307-734-8800",
            "fax_number": "307-734-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDSTROM",
        "first_name": "O'ANN",
        "middle_name": "KARIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WY",
            "license": "5032A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113880400",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Four Pines Physical Therapy Limited Partnership
• Four Pines Physical Therapy PC
• Heather Noelle Franklin, PCSW
• Hannah Lane Fredricks, LCSW
• Nicholas R Fredricks
• Kurt Freischlag, OT
• /Cynthia Ann French, CRNA
• Steven Pirtle French, M.D.
• Jennifer J Fritch, PA
• Fuller Physical Therapy and Wellness, LLC

• Specialist in Jackson, WY
• Providers in Jackson, WY by specialty
• Specialist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.