NPIMap

Individual provider Active NPI

Nathan P Fredrick, DO

  • Emergency Medicine Physician
  • Conway, SC
National Provider Identifier
1871525907
Registry record updated Aug 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
637 Issued in SC
Practice address
300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone
(843) 347-8015
Fax
(843) 347-8017
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 637 SC Primary

Addresses

Primary practice location

300 Singleton Ridge Rd
Conway, SC 29526-9142

Mailing address

PO Box 829
Conway, SC 29528-0829
Phone (843) 347-8015

Other identifiers 5

IdentifierTypeStateIssuer
020051649OtherMEDICARE RAILROAD
0361220182MedicaidIL
T00391MedicaidSC
P00679662OtherRAILROAD MCARE
P00936457OtherILRRMCARE THRU CESIISC (GES)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20081218000708 IL Practitioner - Emergency Medicine 2567557846 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Methodist Medical Center of IllinoisGroup PAC ID 1355259714, shared by 8 NPIs, 387 clinicians

Practice addresses (Care Compare)

221 NE Glen Oak Ave
Peoria, IL 61636-0001
Phone (309) 672-4281

Hospital & facility affiliations

  • Carle Health Proctor Hospital Hospital, Peoria, IL, CCN 140013
  • Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
637SCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois CurrentSince Aug 1, 2017 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Epss, LLC- Metro Series Emergency Medicine CurrentSince Dec 15, 2021 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Aug 1, 2017 Accepting new patients
Epss LLC - Central Series Emergency Medicine CurrentSince Dec 15, 2021 Accepting new patients
Epss Peoria LLC Emergency Medicine CurrentSince Dec 15, 2021 Accepting new patients
Carle Health Care Incorporated Emergency Medicine CurrentSince Jan 1, 2026 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Dec 1, 2024 Accepting new patients
Stephen C. Thompson, M.D.,S.C. Past Accepting new patients
Conway Hospital Emergency Professional Services Emergency Medicine PastSince Feb 4, 2024 Accepting new patients

Locations

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

5409 N Knoxville Ave
Peoria, IL 61614
Phone (309) 691-1000

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: nfredrickdo388495@carlehiedirect.net

Organizations & group practices 10

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.

Hospital & facility affiliations 3

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313539200000",
    "number": "1871525907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 829",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295280829",
            "telephone_number": "843-347-8015",
            "fax_number": "843-347-8017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-347-8015",
            "fax_number": "843-347-8017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICK",
        "first_name": "NATHAN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2011-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "020051649",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0361220182",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T00391",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE",
            "identifier": "P00679662",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCARE THRU CESIISC (GES)",
            "identifier": "P00936457",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.