KEITH J. FREDERICK (DO) – Orthopaedic Surgery Physician, NPI 1366552762
Orthopaedic Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for KEITH J. FREDERICK (DO)
1050 W 10th St
Rolla, MO 654012905
Phone: (573) 364-5633
Fax: (573) 426-5314
Type: Location
1000 W 10th St
Rolla, MO 654012905
Phone: (573) 458-8899
Fax: (573) 341-5611
Type: Location
1050, West 10th Street, Rolla, Phelps County, Missouri, 65401, United States
ROLLA, MO 654012905
Phone: (573) 364-5633
Fax: (573) 426-5314
Type: Location
1000 W 10TH ST
ROLLA, MO 654012905
Phone: (573) 364-9000
Fax: (573) 202-2484
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: 2007-08-31
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 |
|---|---|---|---|---|
| I20070831000280 | I | Orthopedic Surgery | MO | 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 65401)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MO | |
| - | MO | |
| - | MO | |
| Radiation Oncology | MO | |
| Otolaryngology, Plastic And Reconstructive Surgery, Allergy/Immunology | MO | |
| - | MO | |
| Nephrology, Internal Medicine, Hospitalist | MO | |
| - | MO | |
| Nurse Practitioner | MO | |
| Certified Nurse Midwife (Cnm) | MO |
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