DR. JON RANDALL FREDERICK (M.D.) – Emergency Medicine Physician, NPI 1003997800

DR. JON RANDALL FREDERICK (M.D.) is a healthcare provider. based in Mechanicsville, Virginia. specializing in GENERAL PRACTICE, EMERGENCY MEDICINE. They hold the professional credentials M.D.. They hold a License No. 0101242098 (VA). The NPI Number for DR. JON RANDALL FREDERICK (M.D.) is 1003997800

Main info

Male
20 Years Of Experience
Accepts Medicare Assignment
Name
DR. JON RANDALL FREDERICK (M.D.)
NPI
1003997800
Phone
(804) 764-6300
Address
8260 Atlee Rd
Enumeration Date
18 October 2006
Last Update Date
25 October 2024

Doctor Profile

Medical School Name
VIRGINIA COMMONWEALTH UNIVERSITY, SCHOOL OF MEDICINE
Secondary Phone
8049933039
Graduation Year
2006 (20 years ago)
PAC ID
5193944452
Group Practice PAC ID
2961831516
Professional Enrollment ID
I20140918000700
Address ID
VA232944752RI8639XDRXX301
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

130 GENERAL PRACTICE in VA

Provider Addresses for DR. JON RANDALL FREDERICK (M.D.)

  • 8260 Atlee Rd

    Emergency Dept

    Mechanicsville, VA 23116

    Phone: (804) 764-6300

    Fax: (804) 764-6562

    Type: Location

  • 8260, Atlee Road, Mayfield Farms, Mechanicsville, Hanover County, Virginia, 23111, United States

    EMERGENCY DEPT

    MECHANICSVILLE, VA 23116

    Phone: (804) 764-6300

    Fax: (804) 764-6562

    Type: Location

  • 8639 MAYLAND DR STE 102

    RICHMOND, VA 232944752

    Phone: (804) 993-3039

    Fax: (804) 447-1953

    Type: Location

  • Corporate Boulevard, Lafayette, Lafayette Parish, Louisiana, 70502, United States

    LAFAYETTE, LA 705083870

    Phone: (800) 893-9698

    Type: Mailing

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: 2021-10-27

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2023-09-30 (987 days ago).

Enrollment records

2

Earliest due date

2023-09-30

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
I20140918000700IEmergency MedicineVA2023-09-30
I20211027001137IEmergency MedicineDCTBD

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
G2212Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or34820$0
99215Established patient office or other outpatient visit, 40-54 minutes9920$0
View full utilization report →

Insurance plans in this area (ZIP 23116)

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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: 2961831516View full group profile
NameSpecialtyState
Certified Nurse Midwife (Cnm)VA
Clinical Social WorkerVA

Reviews

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Frequently asked questions

What is the 10-digit NPI for DR. JON RANDALL FREDERICK (M.D.)?
DR. JON RANDALL FREDERICK (M.D.) — NPI 1003997800 — is the standard way to identify this listing.
Does the file indicate DR. JON RANDALL FREDERICK (M.D.) is practicing under active NPI?
Directory data currently reports DR. JON RANDALL FREDERICK (M.D.) as active.
What taxonomy line describes DR. JON RANDALL FREDERICK (M.D.)?
For research purposes, treat DR. JON RANDALL FREDERICK (M.D.) as Emergency Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.
What area does DR. JON RANDALL FREDERICK (M.D.) serve?
DR. JON RANDALL FREDERICK (M.D.)'s listing highlights Mechanicsville, Virginia; more addresses can appear in NPPES.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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