Individual provider Active NPI

Melissa A Fredrickson, PA-C

  • Physician Assistant
  • St Augustine, FL
National Provider Identifier
1619245875
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9106223 Issued in FL
Practice address
230 Village Commons Dr
St Augustine, FL 32092-4545
Phone
(904) 940-1441
Fax
(904) 390-7463
NPI assigned
Dec 2, 2011
Last updated
Sep 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9106223 FL Primary

Addresses

Primary practice location

230 Village Commons Dr
St Augustine, FL 32092-4545

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-1032

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120112000576 FL Practitioner - Physician Assistant 2668649773 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Primary Care IncGroup PAC ID 0648177733, 459 clinicians

Practice addresses (Care Compare)

230 Village Commons Dr
St Augustine, FL 32092-4545
Phone (904) 940-1441

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.44 of 100Reported as apm
Quality
84.21
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9106223FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Primary Care Inc CurrentSince Dec 5, 2011 Accepting new patients
Baptist Primary Care Inc CurrentSince Dec 5, 2011 Accepting new patients
Baptist Primary Care Inc Physician Assistant Past Accepting new patients

Locations

1029 Atlantic Blvd
Atlantic Beach, FL 32233
Phone (904) 246-7520

836 Prudential Dr
Ste 1207
Jacksonville, FL 32207
Phone (904) 396-8656

400 Colonnade Dr
Ste 160
Ponte Vedra Beach, FL 32081
Phone (904) 824-1020

98 Nocatee Village Dr
Ponte Vedra Beach, FL 32081
Phone (904) 202-4243

230 Village Commons Dr
Saint Augustine, FL 32092
Phone (904) 940-1441

Interoperability endpoints

  • Direct secure messaging: mfredrickson22590@baptisthealthsystemjacksonville.direct-ci.com

Organizations & group practices 3

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 4

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": "1322784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1619245875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 VILLAGE COMMONS DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320924545",
            "telephone_number": "904-940-1441",
            "fax_number": "904-390-7463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICKSON",
        "first_name": "MELISSA",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-02",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.