NPIMap

Individual provider Active NPI

Edward Dent Frederickson, MD

  • Internal Medicine Physician
  • Clayton, GA
National Provider Identifier
1386710085
Registry record updated Jul 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
032384 Issued in GA
Practice address
156 N Main St
Clayton, GA 30525-4266
Phone
(706) 212-0390
Fax
(706) 960-9209
NPI assigned
Nov 27, 2006
Last updated
Jul 29, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 032384 GA
Internal Medicine Physician 207R00000X 032384 GA Primary

Addresses

Primary practice location

156 N Main St
Clayton, GA 30525-4266

Mailing address

156 N Main St
Clayton, GA 30525-4266
Phone (706) 212-0390

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
I20120203000433 GA Practitioner - Internal MedicinePractitioner - NeurologyPractitioner - Nephrology 9830136100 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Neurology
Education
Emory University School of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

156 N Main St
Clayton, GA 30525-4266
Phone (706) 212-0390

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.32 of 100Reported as individual
Quality
90.64
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
032384GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
David C. Lowance, MD,PC Internal Medicine Current Accepting new patients
Highlands Internal Medicine, PC Internal Medicine CurrentSince Dec 15, 2018 Accepting new patients
Mountain Medical Specilities Inc Internal Medicine CurrentSince Mar 10, 2014 Accepting new patients
Piedmont Nephrology and Internal Medicine, LLC Nephrology Current Accepting new patients

Locations

35 Collier Rd NW
#610
Atlanta, GA 30309

35 Collier Rd NW
Ste 610
Atlanta, GA 30309
Phone (404) 355-2024

156 N Main St
Clayton, GA 30525
Phone (706) 212-0390

Interoperability endpoints

  • Direct secure messaging: edward.frederickson@him2.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/EGIGBD
  • FHIR API: https://fhir4.healow.com/fhir/r4/EGIGBD/Endpoint/EGIGBD

Organizations & group practices 4

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 9

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": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564358400000",
    "number": "1386710085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 N MAIN ST",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305254266",
            "telephone_number": "706-212-0390",
            "fax_number": "706-960-9209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 N MAIN ST",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305254266",
            "telephone_number": "706-212-0390",
            "fax_number": "706-960-9209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKSON",
        "first_name": "EDWARD",
        "middle_name": "DENT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2019-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "032384",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "032384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, GA

Sources for this page

Verify at the official NPI Registry.