Individual provider Active NPI

Angela Fetty

  • Critical Care Pediatric Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1093128530
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Pediatric Nurse PractitionerTaxonomy code 363LP0222X
License
R197016 Issued in MD
Practice address
22 S Greene St
Baltimore, MD 21201-1544
Phone
(410) 328-6453
NPI assigned
Jun 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Pediatric Nurse Practitioner 363LP0222X R197016 MD Primary

Addresses

Primary practice location

22 S Greene St
Baltimore, MD 21201-1544

Mailing address

22 S Greene St
Baltimore, MD 21201-1544
Phone (410) 328-6453

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address afetty144331@direct.wvuhsdirect.com Health Information Exchange (HIE)
Direct Messaging Address afetty144331@direct.wvuhsdirect.com Health Information Exchange (HIE)
Direct Messaging Address afetty144331@direct.wvuhsdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, WV2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160419001548 VA Practitioner - Nurse Practitioner 7517188113 Reassigns benefits to 1 organization
I20200904000000 WV Practitioner - Nurse Practitioner 7517188113 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Associates, P.a.,P.C. CurrentSince Mar 1, 2016 Accepting new patients
West Virginia University Medical Corporation CurrentSince Jan 1, 2023 Accepting new patients
West Virginia University Medical Corporation CurrentSince Jan 1, 2023 Accepting new patients
University Healthcare Physicians Inc CurrentSince Jul 6, 2020 Accepting new patients
University Healthcare Physicians, Inc. CurrentSince Jul 6, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

20010 Century Blvd
Ste 200
Germantown, MD 20874

15225 Heathcote Blvd
Haymarket, VA 20169
Phone (571) 284-1000

24440 Stone Springs Blvd
Sterling, VA 20166
Phone (571) 206-8696

2000 Foundation Way
Ste 3100
Martinsburg, WV 25401
Phone (304) 260-1436

2500 Foundation Way
Martinsburg, WV 25401
Phone (304) 264-9202

2500 Hospital Dr
Martinsburg, WV 25401
Phone (304) 233-4134

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1093128530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-328-6453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-328-6453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTY",
        "first_name": "ANGELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-03",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "MD",
            "license": "R197016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "afetty144331@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2500 Hospital Dr",
            "city": "Martinsburg",
            "state": "WV",
            "country_code": "US",
            "postal_code": "254013402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "afetty144331@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2500 Hospital Dr",
            "city": "Martinsburg",
            "state": "WV",
            "country_code": "US",
            "postal_code": "254013402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "afetty144331@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2500 Hospital Dr",
            "city": "Martinsburg",
            "state": "WV",
            "country_code": "US",
            "postal_code": "254013402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.