NPIMap

Individual provider Active NPI

Jason Robert Fredriksen

  • Diagnostic Radiology Physician
  • Rochester, MN
National Provider Identifier
1477843720
Registry record updated Aug 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
55612 Issued in MN
Practice address
200 1St St SW
Rochester, MN 55905-0001
Phone
(507) 284-2511
NPI assigned
Apr 7, 2011
Last updated
Aug 29, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 106305 MN
Diagnostic Radiology Physician 2085R0202X 55612 MN Primary

Addresses

Primary practice location

200 1St St SW
Rochester, MN 55905-0001

Mailing address

200 1St St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Other identifiers 2

IdentifierTypeStateIssuer
ENROLLEDMedicaidMN
ENROLLEDMedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20170719003087 AZ Practitioner - Diagnostic Radiology 5991961369 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of New Mexico School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yuma Regional Medical CenterGroup PAC ID 2062314826, 367 clinicians
Kingman Healthcare IncGroup PAC ID 6901791367, 185 clinicians

Practice addresses (Care Compare)

2400 S Ave a
Yuma, AZ 85364-7127
Phone (928) 344-2000

3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Phone (928) 757-2101

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
La Paz Regional Hospital Inc CurrentSince Dec 1, 2025 Accepting new patients
Yuma Regional Medical Center CurrentSince Sep 15, 2022 Accepting new patients
Kingman Healthcare, Inc Family Medicine CurrentSince Jul 10, 2017 Accepting new patients
Navajo Health Foundation-Sage Memorial Hospital, Inc. CurrentSince Sep 26, 2025 Accepting new patients
Navajo Health Foundation-Sage Memorial Hospital Inc CurrentSince Sep 26, 2025 Accepting new patients
La Paz Regional Hospital Inc CurrentSince Dec 1, 2025 Accepting new patients
Yuma Regional Medical Center CurrentSince Sep 15, 2022 Accepting new patients
Kingman Healthcare, Inc CurrentSince Jul 10, 2017 Accepting new patients
Mayo Clinic Past Accepting new patients
Kingman Healthcare, Inc Family Medicine Past Accepting new patients

Locations

3269 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-0626

1200 W Mohave Rd
Parker, AZ 85344
Phone (928) 669-7300

2400 S Avenue A
Yuma, AZ 85364
Phone (928) 336-7100

Organizations & group practices 10

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 2

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": "1302134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377734400000",
    "number": "1477843720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRIKSEN",
        "first_name": "JASON",
        "middle_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-07",
        "last_updated": "2013-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "106305",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "55612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.