NPIMap

Individual provider Active NPI

Kristin Lee Fredrickson, D.O.

  • Otolaryngology Physician
  • Hibbing, MN
National Provider Identifier
1912957408
Registry record updated Sep 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
48615 Issued in MN
Practice address
3605 Mayfair Ave
Hibbing, MN 55746-2923
Phone
(218) 262-3441
Fax
(218) 362-6989
NPI assigned
May 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 48615 MN Primary

Addresses

Primary practice location

3605 Mayfair Ave
Hibbing, MN 55746-2923

Mailing address

3605 Mayfair Ave
Hibbing, MN 55746-2923
Phone (218) 262-3441

Other identifiers 1

IdentifierTypeStateIssuer
48615OtherMNMN LIC

Other names 1

  • Dr. Kristin Fredrickson Reckmeyer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20060711000268 MN Practitioner - OtolaryngologyPractitioner - Allergy/ImmunologyPractitioner - Plastic and Reconstructive Surgery 7810900065 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Kansas City University of Physicians and Surgeons, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Range Regional Health ServicesGroup PAC ID 8022920024, 349 clinicians

Practice addresses (Care Compare)

402 E Platt Ave
Nashwauk, MN 55769-1147
Phone (218) 885-2858

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.93 of 100Reported as group
Quality
94.88
Promoting interoperability
100
Improvement activities
40
Cost
78.21

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Range Regional Health Services CurrentSince Jul 1, 2006 Accepting new patients
Range Regional Health Services Current Accepting new patients
Range Regional Health Services CurrentSince Jul 1, 2006 Accepting new patients

Locations

1814 14th Ave E
Hibbing, MN 55746
Phone (218) 262-3441

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

3605 Mayfair Ave
Hibbing, MN 55746
Phone (218) 262-3441

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

Interoperability endpoints

  • Direct secure messaging: kfredrickson285410@fairview.direct-ci.com

Organizations & group practices 3

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 7

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379030400000",
    "number": "1912957408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 MAYFAIR AVE",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557462923",
            "telephone_number": "218-262-3441",
            "fax_number": "218-362-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 MAYFAIR AVE",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557462923",
            "telephone_number": "218-262-3441",
            "fax_number": "218-362-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICKSON",
        "first_name": "KRISTIN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2013-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MN",
            "license": "48615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN LIC",
            "identifier": "48615",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "RECKMEYER",
            "middle_name": "FREDRICKSON",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hibbing, MN

Sources for this page

Verify at the official NPI Registry.