Fredrick Wayne Kersh, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

H4460 Issued in TX

Practice address

3110 Park Center Dr
Tyler, TX 75701-9215

Phone

(903) 593-9999

Fax

(903) 526-4239

NPI assigned

Jun 15, 2006

Last updated

Dec 6, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Angelina Emergency Medicine Associates PA

  • Emergency Medicine Physician
  • Lufkin, TX
  • NPI 1518397298
  Medicare reassignment NPD
• Austin ER Associates PLLC

  • Emergency Medicine Physician
  • Austin, TX
  • NPI 1376114587
  Medicare reassignment NPD
• TK Emergency Physicians Group PLLC

  • Emergency Medicine Physician
  • Houston, TX
  • NPI 1942728019
  Medicare reassignment
• East Texas Medical Center

  dba Etmc EMS

  • Land Ambulance
  • Bellmead, TX
  • NPI 1568964518
  NPD (past)

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1871537621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130757",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757130757",
            "telephone_number": "903-593-9999",
            "fax_number": "903-526-4239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 PARK CENTER DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019215",
            "telephone_number": "903-593-9999",
            "fax_number": "903-526-4239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSH",
        "first_name": "FREDRICK",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H4460",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "H4460",
            "primary": false
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "TX",
            "license": "H4460",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine L Kern
• David Brent Kerns, MD
• Leslie Hunter Kerns, CSFA
• Mary Kerr
• Richard Kerry, LPC
• John Magnus Ketcher, O.D.
• Steven P Keuer, MD
• Samantha Key
• Sandra Key
• Simone Key

• Family Medicine Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.