KYLE MATTHEW FREDRICKSON MD
NPI 1134869696
Pediatrics in Lakeville, MN
About Kyle Matthew Fredrickson Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KYLE MATTHEW FREDRICKSON MD (NPI 1134869696) is an individual pediatrics provider in Lakeville, Minnesota, licensed in Minnesota (82141) and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS, maintains a secondary practice location in Winston Salem, and is a graduate of Other (2022).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kyle Matthew Fredrickson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Kyle Fredrickson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
St Louis Park, MN 55416
- Reassigned Medicare billing, Minnesota enrollment
- Medicare enrollment name: Park Nicollet Clinic
- 2,527 clinicians in this Medicare group
Winston Salem, NC 27157
- Reassigned Medicare billing, North Carolina enrollment
- 3,003 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55044 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 7
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kyle Fredrickson's NPI number?
The NPI number for Kyle Fredrickson is 1134869696. It was assigned to this individual provider in the NPPES registry on March 31, 2022.
Where is Kyle Fredrickson located?
Kyle Fredrickson practices at 18484 Kachina Ct, Lakeville, MN 55044. The listed phone number is (952) 993-8800.
What is Kyle Fredrickson's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is Kyle Fredrickson enrolled in Medicare?
Yes. Kyle Fredrickson is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Kyle Fredrickson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kyle Fredrickson reassigns Medicare benefits to 2 organizations: Park Nicollet Methodist Hospital (St Louis Park, MN) and Wake Forest University Health Sciences (Winston Salem, NC). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kyle Fredrickson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kyle Fredrickson accept?
Health plans from HealthPartners list Kyle Fredrickson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Kyle Fredrickson was last updated on May 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kyle Matthew Fredrickson, MD · NPI 1134869696
Pediatrics physician in Lakeville, Minnesota. Individual provider, active in the CMS NPPES registry since March 31, 2022.
## Identity
- **NPI:** 1134869696 (Entity type: Individual)
- **Enumerated:** March 31, 2022
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** 82141 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 18484 KACHINA CT, Lakeville, MN 55044-4886
- **Phone:** (952) 993-8800
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Park Nicollet Methodist Hospital (NPI 1194113217, St Louis Park, MN); Wake Forest University Health Sciences (NPI 1003803032, Winston Salem, NC) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** May 12, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1134869696) · Data from the CMS NPPES public registry.