Physician Compare National (NPI:1578606893)

HEALTHCARE PROVIDER: DAVID FREDERICKA MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1578606893
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5890751150
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20041209000487
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FREDERICKA
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	NICHOLAS
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	LOYOLA UNIVERSITY OF CHICAGO, STRITCH SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1974
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1753 E MARKET ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	WARREN
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	444836672
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360055
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	STEWARD TRUMBULL MEMORIAL HOSPITAL, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360161
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST JOSEPH WARREN HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360064
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST ELIZABETH YOUNGSTOWN HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	360180
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	CLEVELAND CLINIC
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y