Organization Active NPI

Mark D Fetter MD PC

  • Orthopaedic Hand Surgery Physician
  • Prescott, AZ
National Provider Identifier
1124107206
Registry record updated Oct 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
Legal business name
MARK D FETTER MD PC
Practice address
1615 Petroglyph Point Dr
Prescott, AZ 86301-6539
Phone
(480) 985-1093
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2007

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

Authorized official

Name
Dr. Mark D Fetter, MDNPI 1568427490
Title
President
Phone
(480) 985-1093

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XS0106X Primary

Addresses

Primary practice location

1615 Petroglyph Point Dr
Prescott, AZ 86301-6539

Mailing address

1615 Petroglyph Point Dr
Prescott, AZ 86301-6539
Phone (480) 985-1093

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080307000112 AZ Part B Supplier - Clinic/Group Practice 1052496619 Receives reassigned benefits from 1 practitioner
Practice locations: Prescott, AZ

National Provider Directory

National Provider Directory

Locations

1055 W Iron Springs Rd
Ste B
Prescott, AZ 86305

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1124107206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 PETROGLYPH POINT DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863016539",
            "telephone_number": "480-985-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 PETROGLYPH POINT DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863016539",
            "telephone_number": "480-985-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK D FETTER MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "FETTER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-985-1093",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.