NPIMap

Individual provider Active NPI

Tara Lee Frerks, MD

  • Family Medicine Physician
  • Appleton, WI
National Provider Identifier
1932353315
Registry record updated Mar 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
52283 Issued in WI
Practice address
3916 N Intertech CT
Appleton, WI 54913
Phone
(920) 996-1000
Fax
(920) 996-1054
NPI assigned
Nov 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 32903 SC
Sports Medicine (Family Medicine) Physician 207QS0010X 32903 SC
Family Medicine Physician 207Q00000X 52283 WI Primary

Addresses

Primary practice location

3916 N Intertech CT
Appleton, WI 54913

Mailing address

3916 N Intertech CT
Appleton, WI 54913-6957
Phone (920) 996-1000

Other practice location 1

3111 Gundersen Dr
Onalaska, WI 54650-8447
Phone (608) 775-8630

Other practice location 2

3111 Gundersen Dr
Onalaska, WI 54650-8447
Phone (608) 775-8630

Other identifiers 2

IdentifierTypeStateIssuer
32903OtherSCSC MEDICAL LICENSE, MEDICAL BOARD
52283-020OtherWIWI LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20090424000326 WI Practitioner - Family Practice 2062560378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Care Associates of Appleton, LTDGroup PAC ID 1052348612, 31 clinicians

Practice addresses (Care Compare)

3916 N Intertech CT
Appleton, WI 54913-6957
Phone (920) 996-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32903SCMDFamily Medicine Physician
52283WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Associates of Appleton, LTD Family Medicine CurrentSince Apr 1, 2019 Accepting new patients

Locations

3916 N Intertech Ct
Appleton, WI 54913
Phone (920) 996-1000

Interoperability endpoints

  • Direct secure messaging: tfrerks206168@direct.thedacare.org

Organizations & group practices 1

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 12

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": "1226361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552435200000",
    "number": "1932353315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3916 N INTERTECH CT",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549136957",
            "telephone_number": "920-996-1000",
            "fax_number": "920-996-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3916 N INTERTECH CT",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54913",
            "telephone_number": "920-996-1000",
            "fax_number": "920-996-1054"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3111 Gundersen Dr",
            "address_purpose": "LOCATION",
            "city": "Onalaska",
            "state": "WI",
            "postal_code": "546508447",
            "country_code": "US",
            "telephone_number": "608-775-8630",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3111 Gundersen Dr",
            "address_purpose": "LOCATION",
            "city": "Onalaska",
            "state": "WI",
            "postal_code": "546508447",
            "country_code": "US",
            "telephone_number": "608-775-8630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRERKS",
        "first_name": "TARA",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-11",
        "last_updated": "2019-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "32903",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "SC",
            "license": "32903",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "52283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC MEDICAL LICENSE, MEDICAL BOARD",
            "identifier": "32903",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI LICENSE",
            "identifier": "52283-020",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.