Active NPI
Logan Clay Frederickson, DO
- Family Medicine Physician
- Baker City, OR
National Provider Identifier
1609215573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO176820
- Practice address
- 3705 Midway Dr
Baker City, OR 97814-1456 - Phone
- (541) 519-4250
- Fax
- (541) 239-5259
- NPI assigned
- Jun 24, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DO176820 | OR | Primary |
Addresses
Primary practice location
3705 Midway Dr
Baker City, OR 97814-1456
Mailing address
3705 Midway Dr
Baker City, OR 97814-1456
Phone (541) 519-4250
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DO176820 | Other | OR | MEDICAL LICENSE |
Other names 1
- Logan Clay Williams
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160706000891 | OR | Practitioner - Family Practice | 2860782828 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
3705 Midway Dr
Baker City, OR 97814-1456
Phone (541) 519-4250
Hospital & facility affiliations
- Enhabit Home Health
- St. Alphonsus Medical Center - Baker City
- Grande Ronde Hospital
- St Luke'S Regional Medical Center
- Saint Alphonsus Medical Center - Nampa
- Saint Alphonsus Medical Center Ontario
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 51 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0035 | SD | MD | Registered Dietitian |
| DO176820 | OR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elkhorn Family Medicine PC | Family Medicine | Current | Accepting new patients |
Locations
3705 Midway Dr
Baker City, OR 97814
Phone (541) 523-4497
Interoperability endpoints
- logan.frederickson.1@23554.direct.athenahealth.com
- https://api.platform.athenahealth.com/23554/brand/1/csg/1/fhir/r4
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.
-
- Family Medicine Physician
- Baker City, OR
- NPI 1881263721
Family Medicine, OR
Hospital & facility affiliations 10
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- La Grande, OR
- NPI 1699824938
-
- Critical Access Hospital
- Baker City, OR
- NPI 1386636355
Hospital
-
- General Acute Care Hospital
- Ontario, OR
- NPI 1891891792
Hospital
-
- General Acute Care Hospital
- Nampa, ID
- NPI 1659371870
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706745600000",
"number": "1609215573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3705 MIDWAY DR",
"city": "BAKER CITY",
"state": "OR",
"postal_code": "978141456",
"telephone_number": "541-519-4250",
"fax_number": "541-239-5259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3705 MIDWAY DR",
"city": "BAKER CITY",
"state": "OR",
"postal_code": "978141456",
"telephone_number": "541-519-4250",
"fax_number": "541-239-5259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICKSON",
"first_name": "LOGAN",
"middle_name": "CLAY",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-24",
"last_updated": "2024-02-01",
"certification_date": "2024-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "DO176820",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "DO176820",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LOGAN",
"last_name": "WILLIAMS",
"middle_name": "CLAY",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Baker City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.