Willard Lee Frederickson, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G79707 Issued in CA

Practice address

3315 Watt Ave
Sacramento, CA 95821-3600

Phone

(916) 481-6800

Fax

(916) 481-1881

NPI assigned

Aug 31, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Central Anesthesia Service Exchange Medical Group, Inc.

  • Anesthesiology Physician
  • Sacramento, CA
  • NPI 1194826404
  NPD (past)
• Sacsolano Anesthesia Exchange Medical Group, Inc

  • Anesthesiology Physician
  • Sacramento, CA
  • NPI 1720401284
  NPD (past)

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1821082140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660910",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958660910",
            "telephone_number": "916-481-6800",
            "fax_number": "916-481-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 WATT AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958213600",
            "telephone_number": "916-481-6800",
            "fax_number": "916-481-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKSON",
        "first_name": "WILLARD",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G79707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0028370",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1 Quality Dr",
            "city": "Vacaville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956889494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Paige Herse Fredenburg
• Charles Fredericks, M.D.
• Justin Fredericks
• Cynthia Louise Frederickson, AUD
• Matthew Ryan Frederickson, MD
• Christine Fredrickson, BCBA
• Lauryn Fredrickson
• Rosalba Gabriela Fredrickson
• Free Ride Fox
• Arielle Elizabeth Freed, DDS

• Anesthesiology Physician in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.