Dieter Fellner, DPM
Individual provider Active NPI Foot Surgery Podiatrist · Gorham, NH
NPI 1316280282 · NPPES record last updated Nov 23, 2022
Key facts
- NPI
- 1316280282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot Surgery Podiatrist 213ES0131X
- License
- 0385 (NH)
- Practice address
- 2 Broadway Ave
Gorham, NH 03581-1502 - Phone
- (603) 466-2741
- NPI assigned
- Mar 29, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Coos County Family Health Services Inc
Practice addresses (Care Compare)
133 Pleasant St
Berlin, NH 03570-2006
Phone (603) 752-2040
2 Broadway Ave
Gorham, NH 03581-1502
Phone (603) 466-2741
59 Page Hill Rd
Berlin, NH 03570-3531
Phone (603) 752-2900
Hospital & facility affiliations
- Androscoggin Valley Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, NH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170821001299 | NY | Practitioner - Podiatry | 8820360258 | Reassigns benefits to 1 organization |
| I20221221002614 | NH | Practitioner - Podiatry | 8820360258 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N006747 | NY | MD | Foot Surgery Podiatrist |
| 0385 | NH | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coos County Family Health Services, Inc | Current |
Accepting new patients | |
| Coos County Family Health Services, Inc | Current |
Accepting new patients | |
| Foothurt Podiatry P.C. | Foot Surgery | Past | Accepting new patients |
| Coos County Family Health Services, Inc | Past | Accepting new patients |
Locations
133 Pleasant St
Berlin, NH 03570
Phone (603) 752-2040
2 Broadway Ave
Gorham, NH 03581
Phone (603) 466-2741
167 Main St
#2
Gorham, NH 03581
Phone (603) 466-3500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | N006747 | NY | |
| Foot Surgery Podiatrist | 213ES0131X | 0385 | NH | Yes |
Addresses
Primary practice location
2 Broadway Ave
Gorham, NH 03581-1502
Mailing address
2 Broadway Ave
Gorham, NH 03581-1502
Phone (603) 466-2741
Other providers in Gorham, NH
- Elaine Carol Davis
- Kathleen Donovan
- Dummer School District
- Derek C Eastman
- Errol School District
- Grazyna Galicka-Piskorska
- Amy Lynn Galipeau
- Kimberly Gallant
- William Jay Gessner
- Jameson Giamo
All providers in Gorham, NH · Foot Surgery Podiatrist in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.