FREDERICK MARCUS VICKERY LPPC, LADC
NPI 1215443049
Counselor - Professional in St Louis Park, MN
About Frederick Marcus Vickery Lppc, Ladc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FREDERICK MARCUS VICKERY LPPC, LADC (NPI 1215443049) is an individual professional provider in St Louis Park, Minnesota, licensed in Minnesota (1835) and active in the NPI registry since December 2017. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
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)
Frederick Marcus Vickery Lppc, Ladc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Frederick Vickery reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Minneapolis, MN 55408
- Reassigned Medicare billing, Minnesota enrollment
- 152 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.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
ST LOUIS PARK, MN 55426
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 Frederick Vickery's NPI number?
The NPI number for Frederick Vickery is 1215443049. It was assigned to this individual provider in the NPPES registry on December 15, 2017.
Where is Frederick Vickery located?
Frederick Vickery practices at 6500 Excelsior Blvd, St Louis Park, MN 55426. The listed phone number is (952) 993-5000.
What is Frederick Vickery's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Frederick Vickery enrolled in Medicare?
Yes. Frederick Vickery is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Frederick Vickery's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Frederick Vickery reassigns Medicare benefits to Lyn-Lake Psychotherapy And Wellness Ltd. (Minneapolis, MN). The 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 Frederick Vickery's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Frederick Vickery accept?
Health plans from HealthPartners list Frederick Vickery 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 Frederick Vickery was last updated on September 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 59 days 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.
# Frederick Marcus Vickery, LPPC, LADC · NPI 1215443049
Professional provider in St Louis Park, Minnesota. Individual provider, active in the CMS NPPES registry since December 15, 2017.
## Identity
- **NPI:** 1215443049 (Entity type: Individual)
- **Enumerated:** December 15, 2017
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 1835 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 6500 EXCELSIOR BLVD, St Louis Park, MN 55426-4702
- **Phone:** (952) 993-5000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Lyn-Lake Psychotherapy And Wellness Ltd. (NPI 1609355163, Minneapolis, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 4, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1215443049) · Data from the CMS NPPES public registry.