Individual provider Active NPI

Gayle S Fredere, CRNA

  • Certified Registered Nurse Anesthetist
  • Mobile, AL
National Provider Identifier
1285620674
Registry record updated Dec 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1024624 Issued in AL
Practice address
6508 Bienville CT
Mobile, AL 36695-3259
Phone
(251) 709-6980
NPI assigned
Sep 21, 2005
Last updated
Dec 12, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 1024624 AL Primary
Anesthesiology Physician 207L00000X 1-024624 AL

Addresses

Primary practice location

6508 Bienville CT
Mobile, AL 36695-3259

Mailing address

6508 Bienville CT
Mobile, AL 36695-3259
Phone (251) 709-6980

Other identifiers 6

IdentifierTypeStateIssuer
000057537MedicaidAL
115135OtherALMEDICAID AOC
115141OtherALMEDICAID SMC
051057537OtherALBC OF AL
511-00430OtherALBCBS OF ALABAMA SMC
511-00442OtherALBCBS OF AL - AOC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100614000021 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 7113057407 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesiacare PCGroup PAC ID 2961727169, 19 clinicians

Practice addresses (Care Compare)

2890 Dauphin St
Mobile, AL 36606-2457
Phone (251) 473-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
1-024624ALMDAnesthesiology Physician
1024624ALMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
South Baldwin Anesthesia, PC Anesthesiology CurrentSince Sep 18, 2017 Accepting new patients
M and M Anesthesiology PA Anesthesiology Past Accepting new patients
Teresa G Walker MD PC Anesthesiology Past Accepting new patients
Sheridan Anesthesia Services of Alabama, Inc. Anesthesiology Past Accepting new patients
P R H PC Anesthesiology Past Accepting new patients
Coastal Anesthesia, P.C. Anesthesiology Past Accepting new patients
Anesthesia Services PC Anesthesiology Past Accepting new patients

Locations

1613 N McKenzie St
Foley, AL 36535
Phone (251) 949-3400

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386806400000",
    "number": "1285620674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6508 BIENVILLE CT",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366953259",
            "telephone_number": "251-709-6980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6508 BIENVILLE CT",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366953259",
            "telephone_number": "251-709-6980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERE",
        "first_name": "GAYLE",
        "middle_name": "S",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2013-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1024624",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AL",
            "license": "1-024624",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000057537",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID AOC",
            "identifier": "115135",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID SMC",
            "identifier": "115141",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF AL",
            "identifier": "051057537",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA SMC",
            "identifier": "511-00430",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL - AOC",
            "identifier": "511-00442",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.