Emily Maria Fredericks, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

71014132A Issued in IN

Practice address

801 Broadway
Chesterton, IN 46304-2230

Phone

(219) 763-8112

NPI assigned

Jul 21, 2023

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

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Master of Science - Nursing

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: emily.fredricks.p1@direct.northshorehealth.nextgenshare.com

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.

• Northshore Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lake Station, IN
  • NPI 1356530505
  NPD (past)

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

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1447930623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 STERLING CREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463687752",
            "telephone_number": "219-763-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463042230",
            "telephone_number": "219-763-8112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6050 Sterling Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463687752",
            "country_code": "US",
            "telephone_number": "219-763-8112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "EMILY",
        "middle_name": "MARIA",
        "credential": "CPNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IN",
            "license": "71014132A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Crystal Foster, DPT
• Felicia Foster, MOT, OTR/L
• Natalie R Fox, PA
• Hannah Frain
• Erica L Frederick, OTD, OTR/L
• Mariann J Frigo, OTR
• Nancy A Furcsik, MA, LAT, ATC
• Lisa M Gabrish Grabovac, D.D.S., M.S.
• Deborah J Gallas, M.S., CCC-SLP/L
• Anthony Galoozis

• Pediatric Nurse Practitioner in Chesterton, IN
• Providers in Chesterton, IN by specialty
• Pediatric Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.