Stephanie Grace Dibble Fredericks, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

56 Franklin St
Waterbury, CT 06706-1253

Phone

(203) 709-6000

NPI assigned

Jan 30, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Stephanie Grace Dibble Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Trinity Health of New England Provider Network Organization IncGroup PAC ID 0941113567, 644 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Mary'S Hospital Hospital, Waterbury, CT, CCN 070016

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sfredericks86224@connecticutchildrens.direct-ci.com
• Direct secure messaging: sdibble84895@direct.trinity-health.org

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.

• Trinity Health of New England Provider Network Organization Inc

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1003882812
  Medicare reassignment Care Compare group
• Trinity Health of New England Provider Network Organization Inc

  • Internal Medicine Physician
  • Waterville, ME
  • NPI 1134779531
  NPD

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

• Saint Mary'S Hospital, Inc.

  • General Acute Care Hospital
  • Waterbury, CT
  • NPI 1760426969
  Care Compare affiliation

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

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1326546862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1336 PECK LANE",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "06410",
            "telephone_number": "203-233-4658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 FRANKLIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061253",
            "telephone_number": "203-709-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "STEPHANIE",
        "middle_name": "GRACE DIBBLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-30",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sdibble230883@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "CT Direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "60 Westwood Ave",
            "city": "Waterbury",
            "state": "CT",
            "country_code": "US",
            "postal_code": "067082460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "DIBBLE",
            "middle_name": "GRACE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Franklin Medical Group, PC
• Franklin Medical Group, PC
• Franklin Medical Group, PC
• David Franklin
• William Ghavami Frederick, MD
• Sakinah Nacole Freeman, LMSW
• Anna C Freitag, M.D.
• Anais French
• Brooke Joy French, APRN
• Faige Friedland, MS CCC-SLP

• Medical Physician Assistant in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.