Individual provider Active NPI

Frederick A Cruickshank, M.D.

  • Infectious Disease Physician
  • Huntersville, NC
National Provider Identifier
1659390441
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
2006-01174 Issued in NC
Practice address
103 Commerce Centre Dr
Suite 103
Huntersville, NC 28078-5869
Phone
(704) 948-8582
Fax
(704) 948-8572
NPI assigned
Jul 19, 2006
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2006-01174 NC
Infectious Disease Physician 207RI0200X 2006-01174 NC Primary

Addresses

Primary practice location

103 Commerce Centre Dr
Suite 103
Huntersville, NC 28078-5869

Mailing address

103 Commerce Centre Dr
Suite 103
Huntersville, NC 28078-5869
Phone (704) 948-8582

Other identifiers 2

IdentifierTypeStateIssuer
5908056MedicaidNC
2006-01174OtherNCSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20070213000661 NC Practitioner - Infectious DiseasePractitioner - Internal Medicine 8628009818 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rosedale Health and WellnessGroup PAC ID 8820183346, 4 clinicians

Practice addresses (Care Compare)

103 Commerce Centre Dr
Huntersville, NC 28078-5803

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2006-01174NCMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rosedale Health & Wellness Internal Medicine CurrentSince Feb 5, 2007 Accepting new patients
Bach & Godofsky M D P a Internal Medicine Past Accepting new patients
Pointe West Infectious Diseases P L Infectious Disease Past Accepting new patients

Locations

321 W 11th St
Charlotte, NC 28202
Phone (704) 237-8793

103 Commerce Centre Dr
Ste 103
Huntersville, NC 28078
Phone (704) 947-0044

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1123/brand/1/csg/1/fhir/r4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1659390441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 COMMERCE CENTRE DR",
            "address_2": "SUITE 103",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280785869",
            "telephone_number": "704-948-8582",
            "fax_number": "704-948-8572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 COMMERCE CENTRE DR",
            "address_2": "SUITE 103",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280785869",
            "telephone_number": "704-948-8582",
            "fax_number": "704-948-8572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUICKSHANK",
        "first_name": "FREDERICK",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2006-01174",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NC",
            "license": "2006-01174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5908056",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2006-01174",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntersville, NC

Sources for this page

Verify at the official NPI Registry.