Mr Ryan Timothy Fredricks, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Gilroy, California. His current practice location is
9170 Jacaranda Way, Gilroy, California. You can reach out to his office (for appointments etc.) via phone at
(408) 607-0263.
Mr Ryan Timothy Fredricks is licensed to practice in California (license number 95001662) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1962057034.
Provider's Profile
| Full Name | Mr Ryan Timothy Fredricks |
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| Gender | Male |
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| Speciality | Nurse Anesthetist, Certified Registered |
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| Location | 9170 Jacaranda Way, Gilroy, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1962057034
- Provider Enumeration Date: 08/06/2019
- Last Update Date: 04/08/2023
Medicare PECOS Information:
- PECOS PAC ID: 2163894130
- Enrollment ID: I20230221002130
Medical Identifiers
Medical identifiers for Mr Ryan Timothy Fredricks such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1962057034 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 163W00000X | Registered Nurse | 95135050 (California) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 95001662 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Ryan Timothy Fredricks allows following entities to bill medicare on his behalf.
| Entity Name | Permanente Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1073606299
PECOS PAC ID: 8921910225
Enrollment ID: O20031104000710 |
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| Entity Name | Amsurg Oakland Anesthesia Lp |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1679847727
PECOS PAC ID: 8224292123
Enrollment ID: O20120605000461 |
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| Entity Name | Apa Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1700596111
PECOS PAC ID: 7315303476
Enrollment ID: O20230515002560 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Ryan Timothy Fredricks is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mr Ryan Timothy Fredricks, CRNA
9170 Jacaranda Way,
Gilroy, CA 95020-7417
Ph: (408) 607-0263 | Mr Ryan Timothy Fredricks, CRNA
9170 Jacaranda Way,
Gilroy, CA 95020-7417
Ph: (408) 607-0263 |
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