Individual provider Active NPI

Anne M Frederickson, MD

  • Child & Adolescent Psychiatry Physician
  • Philadelphia, PA
National Provider Identifier
1629259288
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
434036 Issued in PA
Practice address
100 E Lehigh Ave
Philadelphia, PA 19125-1012
Phone
(215) 707-8496
Fax
(215) 707-4086
NPI assigned
Nov 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 25MA09605400 NJ
Child & Adolescent Psychiatry Physician 2084P0804X 434036 PA Primary
Child & Adolescent Psychiatry Physician 2084P0804X 25MA09605400 NJ

Addresses

Primary practice location

100 E Lehigh Ave
Philadelphia, PA 19125-1012

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 707-8496

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150413000082 NJ Practitioner - Psychiatry 8325106222 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Albert Einstein College of Medicine of Yeshiva University, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barnabas Health Medical Group, PCGroup PAC ID 0648172809, 257 clinicians

Practice addresses (Care Compare)

201 Lyons Ave
Newark, NJ 07112-2027
Phone (732) 923-7455

Hospital & facility affiliations

  • Newark Beth Israel Medical Center Hospital, Newark, NJ, CCN 310002

Merit-based Incentive Payment System (MIPS)

Final score
98.51 of 100Reported as apm
Quality
84.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA09605400NJMDNeurology Physician
434036PAMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Barnabas Health Medical Group, PC CurrentSince Aug 1, 2015 Accepting new patients
Rwjbh Observation Associates LLC CurrentSince Oct 28, 2023 Accepting new patients
Newark Beth Israel Medical Center Inc Past Accepting new patients
Newark Beth Israel Medical Center Inc Past Accepting new patients

Locations

201 Lyons Ave
Newark, NJ 07112
Phone (732) 923-7455

110 Rehill Ave
Somerville, NJ 08876
Phone (908) 429-5833

1 Hamilton Health Pl
Trenton, NJ 08690
Phone (609) 584-6763

266 King George Rd
Warren, NJ 07059
Phone (732) 667-7778

223 Monmouth Rd
West Long Branch, NJ 07764
Phone (732) 229-3838

Interoperability endpoints

  • Direct secure messaging: afrederickson43004@epicdirect.rwjbh.org

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1195776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1629259288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-8496",
            "fax_number": "215-707-4086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LEHIGH AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191251012",
            "telephone_number": "215-707-8496",
            "fax_number": "215-707-4086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKSON",
        "first_name": "ANNE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-23",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NJ",
            "license": "25MA09605400",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "PA",
            "license": "434036",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NJ",
            "license": "25MA09605400",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.