Frederick Board

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

2080 S E St
San Bernardino, CA 92408

Phone

(909) 388-9191

Fax

(909) 388-9195

NPI assigned

Sep 14, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Telecare Corporation

  • Health Maintenance Organization
  • San Bernardino, CA
  • NPI 1770741282
  NPD (past)

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

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1316229495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 S E ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924082773",
            "telephone_number": "909-388-9191",
            "fax_number": "909-388-9195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 S E ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92408",
            "telephone_number": "909-388-9191",
            "fax_number": "909-388-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOARD",
        "first_name": "FREDERICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-14",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry Blue
• Blueberry Hill Healthcare Services
• Blueberry Hill Hospice Inc
• Blueberry Hill Hospice LLC
• Bmorenterprise
• Priscilla Bobadilla
• Benita Boben
• Seena Boby, DDS
• Edwin Bogar
• Michael A Boggs

• Case Manager/Care Coordinator in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Case Manager/Care Coordinator in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.