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SAMUEL FREDRICKSON
NPI 1336988930
Marriage & Family Therapist in Madison, WI

Active since May 22, 2024PECOS Enrolled
579 DONOFRIO DR STE 206, MADISON, WI 53719(608) 424-9100 Get Directions Write a Review

NPPES record last updated: May 22, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Samuel Fredrickson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMUEL FREDRICKSON (NPI 1336988930) is an individual marriage & family therapist in Madison, Wisconsin and active in the NPI registry since May 2024. He is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1336988930
Entity TypeIndividualMale
Primary Taxonomy106H00000X
Provider Legal NameSAMUEL FREDRICKSON
Location Address579 DONOFRIO DR STE 206Madison, WI 53719-2839
Mailing Address563 Stonewood CtEvansville, WI 53536-9001 · (920) 960-0548
Phone(608) 424-9100
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateMay 22, 2024
NPPES CertifiedMay 22, 2024
✔ NPI 1336988930 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
579 DONOFRIO DR STE 206, Madison, WI 53719
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Dean Health Plan, Group Health Cooperative-SCW and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

PECOS PAC ID6800355603
PECOS Enrollment IDI20260821004017
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.

Medicare Billing Reassignment

Medicare enrollment records show Samuel Fredrickson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Stateline Mental Health Services
46 mi
Mental Health (Including Community Mental Health Center)
540 E GRAND AVE
Beloit, WI 53511
  • Reassigned Medicare billing, Wisconsin enrollment
  • 34 clinicians in this Medicare group
NPI 1538560255 (608) 368-8087

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

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. EMMA POLZIN MFT-IT
Marriage & Family Therapist
579 DONOFRIO DR STE 206
MADISON, WI 53719
Dane County (608) 424-9100

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 Samuel Fredrickson's NPI number?

The NPI number for Samuel Fredrickson is 1336988930. It was assigned to this individual provider in the NPPES registry on May 22, 2024.

Where is Samuel Fredrickson located?

Samuel Fredrickson practices at 579 Donofrio Dr Ste 206, Madison, WI 53719. The listed phone number is (608) 424-9100.

What is Samuel Fredrickson's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Samuel Fredrickson enrolled in Medicare?

Yes. Samuel Fredrickson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Samuel Fredrickson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Fredrickson reassigns Medicare benefits to Stateline Mental Health Services (Beloit, WI). 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 Samuel Fredrickson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Samuel Fredrickson accept?

Health plans from Anthem Blue Cross and Blue Shield, Dean Health Plan, Group Health Cooperative-SCW, MercyCare Health Plans and Quartz and 1 other insurer list Samuel 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 Samuel Fredrickson was last updated on May 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.