Active NPI
David A. Fredstrom, M.D.
- Family Medicine Physician
- Bend, OR
National Provider Identifier
1285614792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD08366
- Practice address
- 1247 NE Medical Center Dr
C
Bend, OR 97701-3786 - Phone
- (541) 318-4249
- Fax
- (541) 312-5230
- NPI assigned
- Jan 19, 2006
- 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 | MD08366 | OR | Primary |
Addresses
Primary practice location
1247 NE Medical Center Dr
C
Bend, OR 97701-3786
Mailing address
1247 NE Medical Center Dr
3
Bend, OR 97701-3786
Phone (541) 318-4249
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 063347 | Medicaid | OR |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD08366 | OR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bend Memorial Clinic PC | Past | Accepting new patients | |
| Praxis Health, PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Medical Laboratory
- Bend, OR
- NPI 1972144913
-
- Rural Health Clinic/Center
- Dallas, OR
- NPI 1942925326
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278892800000",
"number": "1285614792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1247 NE MEDICAL CENTER DR",
"address_2": "3",
"city": "BEND",
"state": "OR",
"postal_code": "977013786",
"telephone_number": "541-318-4249",
"fax_number": "541-312-5230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1247 NE MEDICAL CENTER DR",
"address_2": "C",
"city": "BEND",
"state": "OR",
"postal_code": "977013786",
"telephone_number": "541-318-4249",
"fax_number": "541-312-5230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDSTROM",
"first_name": "DAVID",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-19",
"last_updated": "2010-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD08366",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "063347",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.