Active NPI
Kyla Fredrickson, MD
- Surgical Critical Care Physician
- Sanford, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Critical Care Physician
- License
- ME169827
- Practice address
- 1401 W Seminole Blvd
Sanford, FL 32771-6743 - Phone
- (608) 397-4223
- NPI assigned
- Mar 26, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Critical Care Physician | 2086S0102X | ME169827 | FL | Primary |
Addresses
Primary practice location
1401 W Seminole Blvd
Sanford, FL 32771-6743
Mailing address
8701 W Watertown Plank Rd
Milwaukee, WI 53226-3548
Other practice location 1
8701 W Watertown Plank Rd
Milwaukee, WI 53226-3548
Phone (414) 955-4575
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- Medical College of Wisconsin, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
305 N Mangoustine Ave
Suite 100
Sanford, FL 32771-1004
Phone (407) 323-7821
Hospital & facility affiliations
- Central Florida Lake Monroe Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME169827 | FL | MD | Surgical Critical Care Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Trauma Services, LLC | Current | Accepting new patients |
Locations
1000 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 374-9610
1887 Kingsley Ave
Ste 1900
Orange Park, FL 32073
Phone (904) 272-9981
305 N Mangoustine Ave
Ste 100
Sanford, FL 32771
Phone (407) 323-7821
1401 W Seminole Blvd
Sanford, FL 32771
Phone (317) 805-2316
2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426
Interoperability endpoints
- kyla.fredrickson@hca4.eclinicaldirectplus.com
Organizations & group practices 1
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.
-
- Trauma Surgery Physician
- Fort Walton Beach, FL
- NPI 1477296952
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Sanford, FL
- NPI 1285681908
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1417452012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8701 W WATERTOWN PLANK RD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 W SEMINOLE BLVD",
"city": "SANFORD",
"state": "FL",
"postal_code": "327716743",
"telephone_number": "608-397-4223"
}
],
"practiceLocations": [
{
"address_1": "8701 W Watertown Plank Rd",
"address_purpose": "LOCATION",
"city": "Milwaukee",
"state": "WI",
"postal_code": "532263548",
"country_code": "US",
"telephone_number": "414-955-4575",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FREDRICKSON",
"first_name": "KYLA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-26",
"last_updated": "2024-09-23",
"certification_date": "2024-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0102X",
"taxonomy_group": "",
"desc": "Surgery, Surgical Critical Care",
"state": "FL",
"license": "ME169827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Sanford, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; 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.