STEPHANIE GRACE DIBBLE FREDERICKS (PA-C) – Medical Physician Assistant, NPI 1326546862
Medical Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
3,244 PHYSICIAN ASSISTANT in CT
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Provider Addresses for STEPHANIE GRACE DIBBLE FREDERICKS (PA-C)
271 BELLA VISTA DR
WATERTOWN, CT 067951360
Phone: (203) 233-4658
Type: Mailing
1336 PECK LANE
CHESHIRE, CT 06410
Phone: (203) 233-4658
Type: Mailing
Saint Mary's Hospital, 56, Franklin Street, Exchange Place, Waterbury, New Haven County, Connecticut, 06706, United States
WATERBURY, CT 067061253
Phone: (203) 709-6000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $147.
Total Amount is formed as General ($147) + Research ($0) + Ownership ($0) = $147.
Last reported payment date: 2023-10-30 • Largest payer in this snapshot: Davol Inc. ($147).
Total Amount
$147
General + Research + Ownership
Payments
1
Total payment records
General Amount
$147
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-10-30
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Davol Inc. | $147 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-04-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20180405001712 | I | Physician Assistant | CT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 06795)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | GA | |
| Nurse Practitioner | CT | |
| Cardiovascular Disease (Cardiology) | CT | |
| - | CT | |
| Emergency Medicine | RI | |
| - | GA | |
| Hospitalist, Internal Medicine, Internal Medicine | CT | |
| G A S T R O E N T E R O L O G Y | CT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | CT | |
| General Surgery, Surgical Oncology | CT |
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