Frederick Joe McKibben, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G55973 Issued in CA

Practice address

100 W California Blvd
Pasadena, CA 91105-3010

Phone

(626) 397-5000

Fax

(626) 397-2912

NPI assigned

Jul 26, 2006

Last updated

Nov 22, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• St. Vincent Anesthesia Medical Group, Inc.

  • Anesthesiology Physician
  • Los Angeles, CA
  • NPI 1164535571
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290384000000",
    "number": "1649294596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80278",
            "city": "CITY OF INDUSTRY",
            "state": "CA",
            "postal_code": "917168278",
            "telephone_number": "503-372-2740",
            "fax_number": "503-372-2554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W CALIFORNIA BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053010",
            "telephone_number": "626-397-5000",
            "fax_number": "626-397-2912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIBBEN",
        "first_name": "FREDERICK",
        "middle_name": "JOE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2010-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G55973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G559730",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G559730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jayson McIsaac
• Janet Lynne McKeehan
• Viviana Andrea McKenney
• Claudette McKenzie-Albin, M.D.
• Angel McKenzie
• Cory McKinsey, PSYD
• Laura Ann McKown, PT
• William McLaughlin
• Brooke Love McLean, PH.D.
• Victoria Elizabeth McLeran

• Anesthesiology Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.