Jordan Frederick, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1155321 Issued in AL

Practice address

125 Bob Lawrence Dr
Winfield, AL 35594-0019

Phone

(205) 487-4535

Fax

(205) 487-8827

NPI assigned

Aug 8, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Group practices

Farouk a Raquib MD PCGroup PAC ID 4688864440, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Farouk a. Raquib, M.D., P.C.

  • Family Medicine Physician
  • Winfield, AL
  • NPI 1760531479

  AL

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1691452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1245913367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1140",
            "city": "WINFIELD",
            "state": "AL",
            "postal_code": "355941140",
            "telephone_number": "205-487-4535",
            "fax_number": "205-487-8827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 BOB LAWRENCE DR",
            "city": "WINFIELD",
            "state": "AL",
            "postal_code": "355940019",
            "telephone_number": "205-487-4535",
            "fax_number": "205-487-8827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "JORDAN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-08",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1155321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "farouk.raquib@winneuro.direct.medconnect-inc.com",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "125 Bob Lawrence Dr",
            "city": "Winfield",
            "state": "AL",
            "country_code": "US",
            "postal_code": "355940019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Farouk a. Raquib, M.D., P.C.
• Christopher Todd Fetter, DC
• Randall W Finley, MD
• Gary Matthew Fowler, MD
• Francisco Huidor MD PC
• Martin M Hajjar, MD
• Hatfield Physician Services, Inc.
• HCC of Winfield LLC
• Heart to Heart Hospice Inc
• John William Holley II, DPT

• Nurse Practitioner in Winfield, AL
• Providers in Winfield, AL by specialty
• Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.