KYLE MATTHEW FREDRICKSON MD
NPI 1134869696
Pediatrics in Lakeville, MN

Q: 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.

Q: What is Kyle Fredrickson's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: 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 2 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.

Active since March 31, 2022PECOS Enrolled

18484 KACHINA CT, LAKEVILLE, MN 55044(952) 993-8800 Get Directions Write a Review

NPPES record last updated: May 12, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 12, 2026, Jan 22, 2026 (2 updates tracked since 2026).

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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 Medical College Of Wisconsin (2022).

NPPES Registry Identity

NPI1134869696

Entity TypeIndividualMale

Primary Taxonomy208000000X

Provider Legal NameKYLE MATTHEW FREDRICKSONCredential: MD

Location Address18484 KACHINA CTLakeville, MN 55044-4886

Mailing Address8170 33rd Ave S # Ms 21110qBloomington, MN 55425-4516

Phone(952) 993-8800

Sole ProprietorNo

Medical School CMSMedical College Of WisconsinGraduated 2022

Enumeration DateMarch 31, 2022

Last NPPES UpdateMay 12, 20262 updates tracked since enumeration

NPPES CertifiedMay 12, 2026

✔ NPI 1134869696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

Licenses✔ Licensed in MN · 82141✔ Licensed in NC · 2025-02382

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

18484 KACHINA CT, Lakeville, MN 55044

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Secondary Practice Location 1

Location 1Medical Center BoulevardWinston Salem, NC 27157-0001 · Phone (336) 716-9252 · Fax (336) 713-9387

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kyle Matthew Fredrickson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2264814870

PECOS Enrollment IDI20260228000280

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

New Patient

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$98.61 typical visit price

range $18.32 – $138.04

Typical copayment $24.65 (range $4.58 – $34.51)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

KELLY LEE WILKINSON MA, LPCC

Counselor (Professional)