DR. FREDERICK P. HAYNES (NPI# 1861409013) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861409013 |
| Entity Type | Individual |
| Full Name | DR. FREDERICK P. HAYNES |
| Credential | M.D. |
| Practice Address |
101 W University Ave Champaign IL 61820-3909 |
| Practice Telephone | 2173661228 |
| Mailing Telephone | 2173668107 |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-10-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 036-042860 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAILROAD MEDICARE | 020016079 | 01 | |
| IL | 036042860 1 | 05 | |
| MEDICARE GROUP | 279500 | 01 |
| Street Address |
101 W UNIVERSITY AVE |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61820-3909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932102969 | Tamara G Helfer | Specialist | 101 W University Ave, Champaign, IL 61820-3981 | 2005-05-23 |
| 1659984540 | Brickston Mellinger | Pharmacist | 101 W University Ave, Champaign, IL 61820-3909 | 2020-08-28 |
| 1477166841 | Amit Patel | Pharmacist | 101 W University Ave, Champaign, IL 61820-3909 | 2020-08-26 |
| 1790320802 | Amy Beth Kutska | Physician Assistant | 101 W University Ave, Champaign, IL 61820-3981 | 2019-11-12 |
| 1093274912 | Alicia Jo Crabtree | Advanced Practice Midwife | 101 W University Ave, Champaign, IL 61820-3981 | 2019-03-19 |
| 1396231767 | Lauren Ashleigh Frerichs | Nurse Practitioner | 101 W University Ave, Champaign, IL 61820-3909 | 2018-07-09 |
| 1700337474 | Annelise Smith | Advanced Practice Midwife | 101 W University Ave, Champaign, IL 61820-3909 | 2016-10-18 |
| 1750836300 | Lindsay Bustle | Advanced Practice Midwife | 101 W University Ave, Champaign, IL 61820-3981 | 2016-08-23 |
| 1922459650 | Kathryn Corgan Mitchell | Physician Assistant | 101 W University Ave, Champaign, IL 61820 | 2016-06-23 |
| 1639572563 | Jacob Backhoff | Pharmacist | 101 W University Ave, Ste 102, Champaign, IL 61820-3909 | 2014-10-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1255963583 | Jamey Richard Bailey | Social Worker | 701 Devonshire Drive, Bldg C, Suite 206, C-6, Champaign, IL 61820 | 2020-02-05 |
| 1790247443 | Jason Abrams | Counselor | 201 W Springfield Ave., Suite 1002-1003, Champaign, IL 61820 | 2019-04-02 |
| 1184100273 | Janine Rafferty | Pharmacist | 2002 N Neil St, Champaign, IL 61820 | 2018-07-12 |
| 1417475070 | Brodbeck Counseling, PC | Community/Behavioral Health | 301 N. Neil Street Suite 323, Champaign, IL 61820 | 2017-09-05 |
| 1447773726 | Quanata M Pelmore | Nurse's Aide | 508 E. Vine St, Champaign, IL 61820 | 2017-07-19 |
| 1821518127 | Molly Mclay | Social Worker | 309 W Clark St., Champaign, IL 61820 | 2017-06-27 |
| 1396265849 | Lou Echols Chambers | Audiologist | 901 South Sixth Street, Chamapign, IL 61820 | 2017-06-26 |
| 1962874495 | Luciana Angelica Guardini | Social Worker | 100 North Chestnut Street, Suite 244, Champaign, IL 61820 | 2015-10-23 |
| 1538544465 | Cpo Services, Inc. | Prosthetic/Orthotic Supplier | 410 E University Ave Ste 105, Champaign, IL 61820 | 2015-07-21 |
| Find all providers in zip 61820 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083753214 | Harry Reed Thompson Jr. | Surgery | 413 E University Ave, Champaign, IL 61820-3826 | 2007-02-05 |
| 1871027151 | Nahstajia Nicole Joy Pinnock | Surgery | 611 West Park Street, Champaign, IL 61822 | 2017-04-13 |
| 1932335130 | Rafael Miguel Ruggieri | Surgery | 101 W University Ave, Champaign, IL 61820-3909 | 2009-06-03 |
| 1720242209 | Cristina Nicolas Medrano | Surgery | 507 S 2nd St, Unit 1- South East, Champaign, IL 61820-5428 | 2008-07-15 |
| 1578761334 | Jennifer Lyne Ash | Surgery | 101 W University Ave, Champaign, IL 61820-3909 | 2007-07-03 |
| 1649287210 | Douglas J. Jones | Surgery | 3101 Fields South Dr, Champaign, IL 61822-3743 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003430166 | Conlan Joseph Pierce | Surgery | 601 W Park St, Urbana, IL 61801 | 2020-06-04 |
| 1376167809 | Francesco Bajani | Surgery | 664 N Dearborn St Apt 2f, Chicago, IL 60654-3848 | 2020-06-01 |
| 1972123099 | Andrea Liu | Surgery | 5841 S Maryland Ave Mc6040, Chicago, IL 60637-1443 | 2020-04-18 |
| 1750917183 | Alberto Maria Fratti | Surgery | 901 S Ashland Ave Apt 711, Chicago, IL 60607-4088 | 2020-03-17 |
| 1841845047 | Barijuve Surgical LLC | Surgery | 380 E Northwest Hwy Ste 200, Des Plaines, IL 60016-2274 | 2019-08-05 |
| 1164081782 | Sean Park | Surgery | 1739 Tudor Ln Unit 308, Northbrook, IL 60062-3778 | 2019-06-07 |
| 1376014175 | Edwardsville Physicians Group LLC | Surgery | 441 South State Route 157 Suite 102, Edwardsville, IL 62025-4012 | 2018-12-06 |
| 1316421324 | Erica Lester | Surgery | John H Stroger, 1969 Ogden Ave, Chicago, IL 60612 | 2018-09-17 |
| 1023513389 | Crystal Siyu Zhang | Surgery | 2160 S 1st Ave Bldg 3210, Maywood, IL 60153 | 2018-03-28 |
| 1376047381 | Richard Lawrence Nelson | Surgery | 1603 W. Taylor St., Room 983, Chicago, IL 60612-4394 | 2018-03-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.