NPIMap

Individual provider Active NPI

Kevin Dale Frederick, M.D.

  • Diagnostic Radiology Physician
  • Danville, PA
National Provider Identifier
1629233572
Registry record updated Jun 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD436166 Issued in PA
Practice address
100 N Academy Ave
M.C. 20-07
Danville, PA 17822-9800
Phone
(570) 271-6301
NPI assigned
Jul 21, 2008
Last updated
Jun 9, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD436166 PA Primary

Addresses

Primary practice location

100 N Academy Ave
M.C. 20-07
Danville, PA 17822-9800

Mailing address

100 N Academy Ave
M.C. 20-07
Danville, PA 17822-9800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kfrederick84032@direct.geisinger.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20090219000195 PA Practitioner - Diagnostic Radiology 6800951211 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians
Geisinger-HM Joint Venture LLCGroup PAC ID 1355676370, 426 clinicians

Practice addresses (Care Compare)

10 Gateway Dr
Reedsville, PA 17084-9641

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144

1000 E Mountain Dr
Wilkes Barre, PA 18711-0027
Phone (570) 826-7300

1020 Thompson St
Jersey Shore, PA 17740-1729
Phone (570) 398-1991

114 LT Michael Cleary Dr
Dallas, PA 18612-1649
Phone (570) 255-1178

1151 N 4TH St
Sunbury, PA 17801-1221

1155 E Mountain Blvd
Wilkes Barre, PA 18702-7906
Phone (570) 808-5135

1175 E Mountain Blvd
Suite 150723
Wilkes Barre, PA 18702-7906
Phone (570) 808-1093

120 Hamm Dr
Lewisburg, PA 17837-7496
Phone (570) 522-9400

1201 Oak St
Pittston, PA 18640-3798
Phone (570) 808-9800

126 Market Way
Mt Pocono, PA 18344-1039
Phone (570) 839-3633

132 Abigail LN
Port Matilda, PA 16870-7153
Phone (814) 272-7100

157 Roosevelt Ave
Selinsgrove, PA 17870-7961
Phone (570) 884-3726

175 Northumberland St
Danville, PA 17821-1508
Phone (570) 284-4575

1800 Mulberry St
Scranton, PA 18510-2369
Phone (570) 969-7355

1824 E 3Rd St
Williamsport, PA 17701-3914
Phone (570) 601-2200

2200 W Front St
GMG Berwick
Berwick, PA 18603-4106
Phone (570) 759-2017

224 N Logan Blvd
Suite 220
Burnham, PA 17009-1850
Phone (717) 242-0196

226 Buckaroo Lane
Bellefonte, PA 16823-9120
Phone (814) 353-3519

240 Mall Blvd
Bloomsburg, PA 17815-8389
Phone (570) 416-5435

25 Church St
Wilkes Barre, PA 18702-3507
Phone (570) 808-3181

27 Cjems LN
Suite 4
Mifflintown, PA 17059-8384
Phone (717) 436-5578

35 S Mountain Blvd
Mountain Top, PA 18707-1122
Phone (570) 474-5847

400 Highland Ave
Lewistown, PA 17044-1167
Phone (717) 363-9071

42 N Main St
Pittston, PA 18640-1916
Phone (570) 654-0880

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD436166PAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger-HM Joint Venture, LLC CurrentSince Sep 24, 2019 Accepting new patients
Geisinger-HM Joint Venture, LLC Diagnostic Radiology Current Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic Diagnostic Radiology CurrentSince Jul 20, 2010 Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Sep 24, 2019 Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

100 N Academy Ave
#2007
Danville, PA 17822
Phone (570) 271-6203

955 Bellefonte Ave
Lock Haven, PA 17745
Phone (570) 748-7714

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

1824 E 3rd St
Williamsport, PA 17701
Phone (570) 322-4422

Interoperability endpoints

  • Direct secure messaging: kfrederick84032@direct.geisinger.edu

Organizations & group practices 5

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 67

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591660800000",
    "number": "1629233572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "address_2": "M.C. 20-07",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178229800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "address_2": "M.C. 20-07",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178229800",
            "telephone_number": "570-271-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "KEVIN",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-21",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD436166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kfrederick84032@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 N Academy Ave",
            "address_2": "M.C. 20-07",
            "city": "Danville",
            "state": "PA",
            "country_code": "US",
            "postal_code": "178229800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Danville, PA

Sources for this page

Verify at the official NPI Registry.