NPIMap

Individual provider Active NPI

Edward John Fricker, MD

  • Gastroenterology Physician
  • Valdosta, GA
National Provider Identifier
1316933823
Registry record updated Oct 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
038487 Issued in GA
Practice address
3207 Country Club Dr
Valdosta, GA 31605-1029
Phone
(229) 242-8480
Fax
(229) 247-7539
NPI assigned
Sep 21, 2005
Last updated
Oct 22, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 038487 GA Primary

Addresses

Primary practice location

3207 Country Club Dr
Valdosta, GA 31605-1029

Mailing address

3207 Country Club Dr
Valdosta, GA 31605-1029
Phone (229) 242-8480

Other identifiers 1

IdentifierTypeStateIssuer
00610915AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050104000215 GA Practitioner - GastroenterologyPractitioner - Internal Medicine 5193773406 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwell Ambulatory IncGroup PAC ID 9234566779, 11 clinicians

Practice addresses (Care Compare)

260 MJ Taylor Rd
Adel, GA 31620-3485
Phone (229) 896-8159

3790 Old US 41
Suite B
Valdosta, GA 31602-6866
Phone (229) 262-6800

901 18TH St E
Tifton, GA 31794-3648
Phone (229) 382-7120

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy194
Upper gastrointestinal (GI) endoscopy for acid reflux354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
038487GAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group of Georgia LLC CurrentSince Apr 5, 2017 Accepting new patients
Southwell Ambulatory Inc Gastroenterology CurrentSince Jan 1, 2020 Accepting new patients
Southwell Ambulatory Inc CurrentSince Jan 1, 2020 Accepting new patients
Privia Medical Group of Georgia LLC CurrentSince Apr 5, 2017 Accepting new patients
Valdosta Medical Clinic CurrentSince Jan 1, 1996 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Southwell Ambulatory Inc Past Accepting new patients
Lowndes County Ambulatory Surgical Center PastSince Nov 1, 2014 Accepting new patients

Locations

260 Mj Taylor Rd
Adel, GA 31620
Phone (229) 247-2290

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

3207 Country Club Rd
Valdosta, GA 31605
Phone (229) 242-8480

3790 Old US Highway 41 N
Ste B
Valdosta, GA 31602
Phone (229) 241-8811

3790 Old US Highway 41 N
Ste C
Valdosta, GA 31602
Phone (229) 241-8811

Interoperability endpoints

  • Direct secure messaging: edward.fricker.1@20731.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/20731/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

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": "1224633600000",
    "number": "1316933823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 COUNTRY CLUB DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316051029",
            "telephone_number": "229-242-8480",
            "fax_number": "229-247-7539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 COUNTRY CLUB DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316051029",
            "telephone_number": "229-242-8480",
            "fax_number": "229-247-7539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRICKER",
        "first_name": "EDWARD",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2008-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "GA",
            "license": "038487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00610915A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.