JENNIFER S FREDERICKS (NPI# 1093743163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093743163 |
| Entity Type | Individual |
| Full Name | JENNIFER S FREDERICKS |
| Credential | MD |
| Practice Address |
820 S Il Route 59 Bartlett IL 60103-1694 |
| Practice Telephone | 6304835930 |
| Practice Fax Number | 6304835939 |
| Mailing Telephone | 6304835930 |
| Mailing Fax Number | 6304835939 |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2013-04-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036106524 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | CDPG HFS PAYEE ID | 3631498336019001 | 01 |
| ID | TAX IDENTIFICATION NUMBER | 36-3149833 | 01 |
| ID | 036106524 | 05 | |
| IL | BLUE CROSS GROUP NUMBER | 0222075 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861686123 | Jennifer Fredericks | Emergency Medicine | @ Columbia Drive, J402, Tampa, FL 33606 | 2007-08-30 |
| Street Address |
820 S IL ROUTE 59 |
| City | BARTLETT |
| State | IL |
| Zip Code | 60103-1694 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831433291 | Central Dupage Physician Group | Orthopaedic Surgery | 820 S Il Route 59, Suite 320, Bartlett, IL 60103-1694 | 2012-11-23 |
| 1932414943 | Mary Jo Zampa | Nurse Practitioner | 820 S Il Route 59, Bartlett, IL 60103-1694 | 2010-08-13 |
| 1265462089 | Rolf R Stavig | Family Medicine | 820 S Il Route 59, Suite A, Bartlett, IL 60103-1694 | 2006-07-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467916593 | Nicole Taylor Gerdevich | Specialist/Technologist | 1302 Branden Lane, Bartlett, IL 60103 | 2019-01-23 |
| 1154817823 | Ada Oguejiofor | Registered Nurse | 269 Norway Drive, Bartlett, IL 60103 | 2018-07-06 |
| 1295153765 | Paul Alegro | Physical Therapy Assistant | 810 Seacrest Lane, Bartlett, IL 60103 | 2014-04-02 |
| 1184051211 | John Katsis | Dentist | 110 S. Oak Avenue, Bartlett, IL 60103 | 2013-10-03 |
| 1356786743 | Rajiv Puri PC | Dentist | 849 S Route 59, Bartlett, IL 60103 | 2013-04-30 |
| 1356786784 | Gilbert Noble Bael | Physical Therapist | 829 Carillon Drive, Bartlett, IL 60103 | 2013-04-29 |
| 1912282641 | Elaine S Tate | Pharmacist | 891 S. Route 59, Bartlett, IL 60103 | 2011-10-13 |
| 1104108968 | Sonal Vyas | Pharmacist | 891 S. Route 59, Bartlett, IL 60103 | 2011-09-16 |
| 1144502261 | Les Edward Wingert | Pharmacist | 891 South Route 59, Bartlett, IL 60103 | 2011-09-14 |
| 1629389564 | Hope Hebert | Counselor | 364 Sundance Drive, Bartlett, IL 60103 | 2010-06-25 |
| Find all providers in zip 60103 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326677907 | Hamad Ahmad Md PC | Family Medicine | 6490 Memphis Arlington Rd Suite 106, Bartlett, TN 38135 | 2020-04-06 |
| 1851734347 | Katherine Oakley Kopinski | Family Medicine | 2589 Appling Rd, #101, Bartlett, TN 38133-5099 | 2013-04-15 |
| 1033437868 | Michelle A. Shelton, Md, LLC | Family Medicine | 5146 Stage Rd Ste 101, Bartlett, TN 38134-3139 | 2010-05-04 |
| 1891970984 | John Joseph Lang IIi | Family Medicine | 3805 Thistle Ridge Ln, Bartlett, TN 38135-7420 | 2008-01-08 |
| 1235259656 | Sanuka Medical Center Sc | Family Medicine | 114 Bartlett Plz, Bartlett, IL 60103-4234 | 2007-03-30 |
| 1235268517 | Tri Minh Nguyen | Family Medicine | 6570 Stage Rd Ste 245, Bartlett, TN 38134-2840 | 2007-03-05 |
| 1821020587 | Carrie Louise Dowling | Family Medicine | 7140 Stage Road, Suite 106, Bartlett, TN 38133-8955 | 2006-07-06 |
| 1023046414 | Charles Kalenowski | Family Medicine | 1041 W Stearns Rd, Bartlett, IL 60103-4509 | 2006-06-28 |
| 1114970258 | Family Care Group PC | Family Medicine | 6555 Stage Rd, Suite 1, Bartlett, TN 38134-2810 | 2006-05-18 |
| 1114984895 | Jorge E Martinez | Family Medicine | 166 Bartlett Plz, Bartlett, IL 60103-4234 | 2006-04-27 |
| Find all providers in BARTLETT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.