Michael Roy Fredericks, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

0101233036 Issued in VA

Practice address

1040 Main St
Danville, VA 24541-1816

Phone

(434) 792-1433

Fax

(434) 797-2807

NPI assigned

Apr 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in VA, NC2 enrollments

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 2

Specialty

Internal MedicineAlso: Nephrology

Education

Saint Louis University School of Medicine, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Danville Urologic Clinic IncGroup PAC ID 8022067743, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Renal Care Group - South Boston Dialysis facility, South Boston, VA, CCN 492516
• Fresenius Kidney Care of Halifax Dialysis facility, South Boston, VA, CCN 492725
• Sentara Halifax Regional Hospital Hospital, South Boston, VA, CCN 490013

Merit-based Incentive Payment System (MIPS)

Final score

90.15 of 100Reported as group

Quality

77.23

Promoting interoperability

97

Improvement activities

40

Cost

80.32

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mfredericks29207@direct.acumenmd.com

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.

• Danville Urologic Clinic Inc

  • Nephrology Physician
  • Danville, VA
  • NPI 1619927100

  NC

  Medicare reassignment Care Compare group NPD
• Piedmont Day Surgery Center Inc

  • Ambulatory Surgical Clinic/Center
  • Danville, VA
  • NPI 1821064031
  NPD (past)

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

• Bio-Medical Applications of Virginia, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • South Boston, VA
  • NPI 1841700960

  Dialysis facility

  Care Compare affiliation Name & address match
• Renal Care Group of the South, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • South Boston, VA
  • NPI 1437261252

  Dialysis facility

  Care Compare affiliation Name & address match
• Halifax Regional Hospital, Inc.

  • General Acute Care Hospital
  • South Boston, VA
  • NPI 1588668842
  Care Compare affiliation

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433289600000",
    "number": "1699730341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 MAIN ST",
            "address_2": "P.O. BOX 1360",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411816",
            "telephone_number": "434-792-1433",
            "fax_number": "434-797-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 MAIN ST",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411816",
            "telephone_number": "434-792-1433",
            "fax_number": "434-797-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "MICHAEL",
        "middle_name": "ROY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2015-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0101233036",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "200300471",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7433254",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "384373",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89065HO",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010131669",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "171782",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in Danville, VA
• Providers in Danville, VA by specialty
• Nephrology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.