Individual provider Active NPI

Kyla Fredrickson, MD

  • Surgical Critical Care Physician
  • Sanford, FL
National Provider Identifier
1417452012
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
ME169827 Issued in FL
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

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241023004425 FL Practitioner - General Surgery 5991125858 Reassigns benefits to 1 organization

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
Florida Trauma Services LLCGroup PAC ID 3971985938, 92 clinicians

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 Hospital, Sanford, FL, CCN 100161

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME169827FLMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Trauma Services, LLC CurrentSince Oct 1, 2024 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 1

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": "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

Verify at the official NPI Registry.