James Denzil Frederick, MD
Individual provider Active NPI Family Medicine Physician · West Liberty, KY
NPI 1881798502 · NPPES record last updated Jan 10, 2014
Key facts
- NPI
- 1881798502
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 16783 (KY)
- Practice address
- 430 Liberty Rd
West Liberty, KY 41472 - Phone
- (606) 743-3114
- Fax
- (606) 743-1404
- NPI assigned
- Sep 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 6
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Louisville School of Medicine, 1972
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Frederick Medical Clinic PSC
Practice addresses (Care Compare)
430 Liberty Rd
West Liberty, KY 41472-2049
Phone (606) 487-1722
Hospital & facility affiliations
- Morgan County Arh HHA
- Morgan County Arh Hospital
- St Claire Regional Medical Center
- Saint Joseph East
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Dean Dorton Healthcare Solutions LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) W-2 Managing Employee (100%) Operational/Managerial Control (100%) |
Jul 1, 1975 Jul 1, 1975 Jul 1, 1975 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040924000094 | KY | Practitioner - Family Practice | 3971571100 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick & Smith Inc | Current | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 16783 | KY | Yes |
Addresses
Primary practice location
430 Liberty Rd
West Liberty, KY 41472
Mailing address
PO Box 607
West Liberty, KY 41472-0607
Phone (606) 743-3114
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64167836 | Medicaid | KY |
Other providers in West Liberty, KY
- Phyllis Ann Eldridge
- Faith Family Practice PLLC
- Crystal Marie Fletcher-Jones
- Frederick & Smith Inc
- Frederick Medical Clinic PSC
- Melissa Lynn Frederick
- Kristen Fredricks
- Kara Fyffe
- Dena Michelle Garrett
- Gateway District Health Department
All providers in West Liberty, KY · Family Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.