Ditina Jade Frederick, LMT, CHT, RM

Primary specialty

SpecialistTaxonomy code 174400000X

License

MT-07881 Issued in AZ

Practice address

6730 E McDowell Rd Ste 139
Scottsdale, AZ 85257-3135

Phone

(602) 931-7817

NPI assigned

Dec 17, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1376789693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6730 E MCDOWELL RD STE 139",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852573135",
            "telephone_number": "602-931-7817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6730 E MCDOWELL RD STE 139",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852573135",
            "telephone_number": "602-931-7817"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4408 N 35th St",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850183936",
            "country_code": "US",
            "telephone_number": "623-451-4142",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "DITINA",
        "middle_name": "JADE",
        "credential": "LMT,  CHT, RM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-17",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "MT-07881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://provider.kareo.com/ditina-jade",
            "affiliation": "N",
            "endpointDescription": "Kareo Provider",
            "address_1": "6730 E McDowell Rd Ste 139",
            "city": "Scottsdale",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852573135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Frederick S. Simonie M.D. P.C.
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• Specialist in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; 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.