NPIMap

Individual provider Active NPI

Wayne Ai Frederick, MD

  • Surgical Oncology Physician
  • Washington, DC
National Provider Identifier
1962408252
Registry record updated Sep 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
License
MD30905 Issued in DC
Practice address
2041 Georgia Ave NW
Ste 4000
Washington, DC 20060-0001
Phone
(202) 865-6237
Fax
(860) 679-1390
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Oncology Physician 2086X0206X MD30905 DC Primary
Surgery Physician 208600000X MD30905 DC
Surgery Physician 208600000X 041334 CT

Addresses

Primary practice location

2041 Georgia Ave NW
Ste 4000
Washington, DC 20060-0001

Mailing address

6138 31St PL NW
Washington, DC 20015-1502
Phone (202) 865-6237

Other identifiers 3

IdentifierTypeStateIssuer
010266505MedicaidVA
037841900MedicaidDC
410159600MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20061019000256 DC Practitioner - General Surgery 7113917808 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041334CTMDSurgery Physician
MD30905DCMDSurgical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Howard University Surgery CurrentSince Jul 28, 2014 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

2041 Georgia Ave NW
Washington, DC 20060
Phone (202) 865-3785

2041 Georgia Ave NW
Ste 4000
Washington, DC 20060
Phone (202) 865-3785

2041 Georgia Ave NW
Ste 2322
Washington, DC 20060
Phone (202) 865-4203

2101 Medical Park Dr
Ste 305
Silver Spring, MD 20902
Phone (301) 754-0833

Interoperability endpoints

  • Direct secure messaging: waynefrederick@hufp.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hospital for Special SurgeryNew York, NY, CCN 330270 Hospital Corporate Director Nov 3, 2023

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1962408252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6138 31ST PL NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200151502",
            "telephone_number": "202-865-6237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 GEORGIA AVE NW",
            "address_2": "STE 4000",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200600001",
            "telephone_number": "202-865-6237",
            "fax_number": "860-679-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "WAYNE",
        "middle_name": "AI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "DC",
            "license": "MD30905",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "DC",
            "license": "MD30905",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CT",
            "license": "041334",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010266505",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037841900",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410159600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.