Active NPI
Karie Lynn Fedorick, PA-C
- Medical Physician Assistant
- Gilbert, AZ
National Provider Identifier
1689735482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 2779
- Practice address
- 2915 E Baseline Rd Ste 101
Gilbert, AZ 85234-2427 - Phone
- (480) 776-0626
- Fax
- (480) 776-0627
- NPI assigned
- Dec 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2779 | AZ | |
| Medical Physician Assistant | 363AM0700X | 2779 | AZ | Primary |
Addresses
Primary practice location
2915 E Baseline Rd Ste 101
Gilbert, AZ 85234-2427
Mailing address
4545 E Chandler Blvd Ste 206
Phoenix, AZ 85048-7645
Phone (480) 961-5956
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2779 | AZ | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aloha Cardiology P.C. | Past | Accepting new patients | |
| Forever Family Healthcare LLC | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Phoenix, AZ
- NPI 1063640977
-
- Legal Medicine
- Gilbert, AZ
- NPI 1669437349
-
- Specialist
- Gilbert, AZ
- NPI 1659703650
-
- Family Medicine Physician
- Phoenix, AZ
- NPI 1346301629
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681257600000",
"number": "1689735482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4545 E CHANDLER BLVD STE 206",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850487645",
"telephone_number": "480-961-5956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2915 E BASELINE RD STE 101",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852342427",
"telephone_number": "480-776-0626",
"fax_number": "480-776-0627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDORICK",
"first_name": "KARIE",
"middle_name": "LYNN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-13",
"last_updated": "2023-04-12",
"certification_date": "2023-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "2779",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "2779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.