John Frederick, M.D.
Individual provider Active NPI Hospitalist Physician · Dyer, IN
NPI 1598027153 · NPPES record last updated Mar 19, 2021
Key facts
- NPI
- 1598027153
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hospitalist Physician 208M00000X
- License
- 01076100A (IN)
- Practice address
- 24 Joliet St
Dyer, IN 46311-1705 - Phone
- (219) 865-2141
- NPI assigned
- Jun 11, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Florida Hospital Healthcare Partners, Inc
Practice addresses (Care Compare)
1000 Waterman Way
Tavares, FL 32778-5266
Phone (352) 742-3581
Hospital & facility affiliations
- Adventhealth Waterman
- Adventhealth Waterman
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210914001735 | FL | Practitioner - Internal Medicine | 4486962446 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036138817 | IL | MD | Internal Medicine Physician |
Practice roles (1 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Hospital Healthcare Partners, Inc | Internal Medicine | Current |
Accepting new patients |
Locations
1055 Saxon Blvd
Orange City, FL 32763
Phone (386) 917-5000
60 Memorial Medical Pkwy
Palm Coast, FL 32164
Phone (385) 586-2000
1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Interoperability endpoints
- jfrederick81718@adventhealth.direct-ci.com
- jfrederick211493@direct.franciscanalliance.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 01076100A | IN | |
| Internal Medicine Physician | 207R00000X | 036138817 | IL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Hospitalist Physician | 208M00000X | 01076100A | IN | Yes |
Addresses
Primary practice location
24 Joliet St
Dyer, IN 46311-1705
Mailing address
PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800
Other practice location 1
2525 S Michigan Ave
ATTN:Internal Medicine Residency Program
Chicago, IL 60616
Phone (312) 567-2053
Other practice location 2
2525 S Michigan Ave
ATTN:Internal Medicine Residency Program
Chicago, IL 60616
Phone (312) 567-2053
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201338270 | Medicaid | IN | |
| F400244803 | Other | IL | MEDICARE PTAN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jfrederick211493@Direct.FranciscanAlliance.org | Direct |
Other providers in Dyer, IN
- Franciscan Physicians Hospital, LLC
- Franciscan Senior Health and Wellness Dyer
- Franciscan St Margaret Health
- Kimberly Sue Frank
- Frazierworks Home Health Agency, Inc
- Fresenius Medical Care NW Indiana, LLC
- Erik Frost
- Victoria Gall
- Dianna Galvan
- Nancy Fabiola Gamarra Flores
All providers in Dyer, IN · Hospitalist Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.