NPIMap

Individual provider Active NPI

Nicholas Aaron Fettman, MD

  • Otolaryngology Physician
  • Oxnard, CA
National Provider Identifier
1003005109
Registry record updated Nov 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A116624 Issued in CA
Practice address
1700 N Rose Ave
Suite 460
Oxnard, CA 93030-3790
Phone
(805) 983-0395
Fax
(805) 983-0463
NPI assigned
Oct 15, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X A116624 CA Primary

Addresses

Primary practice location

1700 N Rose Ave
Suite 460
Oxnard, CA 93030-3790

Mailing address

2876 Sycamore Dr
Suite 303
Simi Valley, CA 93065-1530
Phone (805) 527-7320

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110804000187 CA Practitioner - Otolaryngology 7214106418 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Ohio State University College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Memorial Health SystemGroup PAC ID 9537155676, 187 clinicians

Practice addresses (Care Compare)

2361 E Vineyard Ave
Oxnard, CA 93036-2102
Phone (805) 981-3770

Hospital & facility affiliations

  • Community Memorial Hospital - Ventura Hospital, Ventura, CA, CCN 050394

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A116624CAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Coast Ear Nose and Throat CurrentSince Aug 1, 2011 Accepting new patients
Community Memorial Health System CurrentSince Jan 1, 2024 Accepting new patients
Community Memorial Health System CurrentSince Jan 1, 2024 Accepting new patients
Community Memorial Health System Current Accepting new patients
Simi Valley Hospital and Health Care Services Past Accepting new patients

Locations

422 Arneill Rd
Ste B
Camarillo, CA 93010
Phone (805) 383-4510

2361 E Vineyard Ave
Oxnard, CA 93036
Phone (805) 981-3770

1700 N Rose Ave
Ste 460
Oxnard, CA 93030
Phone (805) 983-0395

2921 Saviers Rd
Oxnard, CA 93033
Phone (805) 487-5588

2876 Sycamore Dr
Ste 303
Simi Valley, CA 93065
Phone (805) 527-7320

301 S Moorpark Rd
Thousand Oaks, CA 91361
Phone (805) 379-0824

5855 Olivas Park Dr
Ventura, CA 93003
Phone (805) 652-5469

138 W Main St
Ste E
Ventura, CA 93001
Phone (805) 667-2850

147 N Brent St
Ventura, CA 93003
Phone (805) 652-5011

Interoperability endpoints

  • Direct secure messaging: nicholasfettman@cfh.allscriptsdirect.net
  • FHIR API: https://fhir.ssmhc.com/Fhir/MyChart/api/FHIR/R4
  • Direct secure messaging: nfettman3518371@oc.providencedirect.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574812800000",
    "number": "1003005109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2876 SYCAMORE DR",
            "address_2": "SUITE 303",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651530",
            "telephone_number": "805-527-7320",
            "fax_number": "805-527-2426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N ROSE AVE",
            "address_2": "SUITE 460",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930303790",
            "telephone_number": "805-983-0395",
            "fax_number": "805-983-0463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTMAN",
        "first_name": "NICHOLAS",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-15",
        "last_updated": "2019-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A116624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oxnard, CA

Sources for this page

Verify at the official NPI Registry.