EMILY M FREDERICKS (PHD) – Clinical Child & Adolescent Psychologist, NPI 1033225420

EMILY M FREDERICKS (PHD) is a healthcare provider. based in Ann arbor, Michigan. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PHD. They hold a License No. 6301012365 (MI). The NPI Number for EMILY M FREDERICKS (PHD) is 1033225420

Main info

Female
21 Years Of Experience
Accepts Medicare Assignment
Name
EMILY M FREDERICKS (PHD)
NPI
1033225420
Phone
(734) 647-5299
Address
3621 S STATE ST
Enumeration Date
21 August 2006
Last Update Date
19 October 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7347639259
Graduation Year
2005 (21 years ago)
PAC ID
9830118256
Group Practice PAC ID
3779496856
Professional Enrollment ID
I20051115000829
Address ID
MI481052969AN2101XBLVD300
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience67
Completeness75
Years active:19State licenses:1Digital endpointsOther names

1,225 CLINICAL PSYCHOLOGIST in MI

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Provider Addresses for EMILY M FREDERICKS (PHD)

  • South State Street, Ann Arbor, Washtenaw County, Michigan, 48108-1774, United States

    ANN ARBOR, MI 481081633

    Phone: (734) 647-5299

    Type: Mailing

  • Mott Children's Hospital and Von Voigtlander Women's Hospital, 1500, East Medical Center Drive, Ann Arbor, Washtenaw County, Michigan, 48109, United States

    ANN ARBOR, MI 481095000

    Phone: (734) 936-4000

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2005-11-15

PECOS data refreshed: 2026-06-15

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20051115000829IClinical PsychologistMITBD

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.

Verify on CMS Revalidation Lookup Tool

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 48108)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3779496856View full group profile
NameSpecialtyState
G A S T R O E N T E R O L O G YFL
Physical Medicine And RehabilitationMI
A N E S T H E S I O L O G YMI
-MI
-MI
Clinical Social WorkerMI
Interventional RadiologyMI

Reviews

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Frequently asked questions

Is there an official ID for EMILY M FREDERICKS (PHD) in U.S. healthcare records?
The official identifier for EMILY M FREDERICKS (PHD) is NPI 1033225420.
Is EMILY M FREDERICKS (PHD) still an active registrant?
EMILY M FREDERICKS (PHD) carries an active NPI according to the public dataset.
What kind of doctor is EMILY M FREDERICKS (PHD)?
EMILY M FREDERICKS (PHD) is associated with Clinical Child & Adolescent Psychologist in the directory — Clinical services aligned with this taxonomy classification.
Is EMILY M FREDERICKS (PHD) associated with Ann Arbor?
Public fields place EMILY M FREDERICKS (PHD) around Ann Arbor, Michigan. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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