NPIMap

Individual provider Active NPI

Ruth Kellum Fredericks, M.D.

  • Neurology Physician
  • Jackson, MS
National Provider Identifier
1730138843
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
11722 Issued in MS
Practice address
971 Lakeland Dr
Suite 557
Jackson, MS 39216-4643
Phone
(601) 200-4560
Fax
(601) 326-4632
NPI assigned
May 8, 2006
Last updated
Apr 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 11722 MS
Neurology Physician 2084N0400X 11722 MS Primary
Neurology Physician 2084N0400X COVID19-TMP-427 LA

Addresses

Primary practice location

971 Lakeland Dr
Suite 557
Jackson, MS 39216-4643

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4749

Other practice location 1

309 Jackson St Ste 320
Monroe, LA 71201-7407
Phone (318) 966-8820

Other practice location 2

810 E Sunflower Rd Ste 100J
Cleveland, MS 38732-2828
Phone (601) 200-4560

Other practice location 3

4204 Clay St
Vicksburg, MS 39183-3438
Phone (601) 200-4560

Other practice location 4

969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-3631

Other identifiers 1

IdentifierTypeStateIssuer
00113670MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071107000197 MS Practitioner - NeurologyPractitioner - Gynecological Oncology 7012947476 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St. Dominic Jackson MemorialGroup PAC ID 4385531847, 56 clinicians

Practice addresses (Care Compare)

106 Highland Way
Madison, MS 39110-6933

969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-3100

971 Lakeland Dr
Suite 557
Jackson, MS 39216-4661
Phone (601) 200-4560

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as apm
Quality
73.43
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11722MSMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Dominic Jackson Memorial CurrentSince Apr 1, 2025 Accepting new patients
St Dominic Medical Associates LLC CurrentSince Feb 2, 2013 Accepting new patients
St. Dominic Medical Associates LLC Neurology Current Accepting new patients
St Dominic Hospital Crna's CurrentSince Apr 1, 2025 Accepting new patients
St Dominic Medical Associates LLC CurrentSince Feb 2, 2013 Accepting new patients
St Francis Medical Center, Inc Past Accepting new patients
Ruth K. Fredericks, M.D. Neurology PastSince Nov 16, 1993 Accepting new patients
St Dominic Medical Associates LLC Past Accepting new patients
University Neurology Group, PLLC Neurology Past Accepting new patients

Locations

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

810 E Sunflower Rd
Ste 100J
Cleveland, MS 38732
Phone (601) 200-4560

969 Lakeland Dr
Jackson, MS 39216
Phone (601) 200-4644

971 Lakeland Dr
Ste 557
Jackson, MS 39216
Phone (601) 200-4560

106 Highland Way
Ste 202
Madison, MS 39110
Phone (601) 200-3376

4204 Clay St
Vicksburg, MS 39183
Phone (601) 200-4560

Interoperability endpoints

  • Direct secure messaging: rfredericks2548776@direct.casso.us.com

Organizations & group practices 9

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.

Hospital & facility affiliations 10

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": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1730138843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-4749",
            "fax_number": "601-200-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR",
            "address_2": "SUITE 557",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164643",
            "telephone_number": "601-200-4560",
            "fax_number": "601-326-4632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "309 Jackson St Ste 320",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712017407",
            "country_code": "US",
            "telephone_number": "318-966-8820",
            "fax_number": "318-966-8827",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "810 E Sunflower Rd Ste 100J",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "MS",
            "postal_code": "387322828",
            "country_code": "US",
            "telephone_number": "601-200-4560",
            "fax_number": "601-200-4580",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4204 Clay St",
            "address_purpose": "LOCATION",
            "city": "Vicksburg",
            "state": "MS",
            "postal_code": "391833438",
            "country_code": "US",
            "telephone_number": "601-200-4560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "969 Lakeland Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164606",
            "country_code": "US",
            "telephone_number": "601-200-3631",
            "fax_number": "601-200-0159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "RUTH",
        "middle_name": "KELLUM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-08",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "11722",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MS",
            "license": "11722",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "LA",
            "license": "COVID19-TMP-427",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00113670",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.