John Thomas Frederick, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD00036632 Issued in WA

Practice address

1200 5TH Ave Ste 2010
Seattle, WA 98101-3100

Phone

(206) 778-5584

NPI assigned

Feb 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 26, 2015 through Jun 26, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519084800000",
    "number": "1790828911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 5TH AVE STE 2010",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981013100",
            "telephone_number": "206-778-5584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 5TH AVE STE 2010",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981013100",
            "telephone_number": "206-778-5584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "JOHN",
        "middle_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2018-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "WA",
            "license": "MD00036632",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00036632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VM AETNA PCP PIN",
            "identifier": "US7536792",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VM LABOR AND INDUSTRIES #",
            "identifier": "0163635",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VM BLUE SHIELD #",
            "identifier": "3015FR",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8286858",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - SNO CO",
            "identifier": "8883129",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VM RAILROAD MC #",
            "identifier": "P00444827",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kate Jeanine Fredenberg, LICSW, CDP
• Frederick B Davis MD PS
• Christina Frederick, MD, MPH
• Fallon L Frederick, PTA
• James Todd Frederick, D.C.
• Shanna E Frederick, DC
• Julia Nancy Fredericks, DMD
• Margo Badman Fredericks, FNP-BC, ARNP
• Ryan Michael Fredericks, MD
• Jason Regis Fredrick, MD, MPH

• Psychiatry Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.