Active NPI
Bruce G Fawcett, DPM
- Podiatrist
- Raleigh, NC
National Provider Identifier
1336238336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 154
- Practice address
- 1514 Glenwood Ave
Raleigh, NC 27608-2368 - Phone
- (919) 829-0076
- Fax
- (919) 836-9094
- NPI assigned
- Oct 11, 2006
- Last updated
- Apr 4, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 154 | NC | Primary |
| Public Medicine Podiatrist | 213EP0504X | 154 | NC | |
| Primary Podiatric Medicine Podiatrist | 213EP1101X | 154 | NC | |
| Radiology Podiatrist | 213ER0200X | 154 | NC | |
| Sports Medicine Podiatrist | 213ES0000X | 154 | NC | |
| Foot Surgery Podiatrist | 213ES0131X | 154 | NC |
Addresses
Primary practice location
1514 Glenwood Ave
Raleigh, NC 27608-2368
Mailing address
1514 Glenwood Avenue
Raleigh, NC 27608-2368
Phone (919) 829-0076
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2751610 | Other | NC | UNITED |
| 08064 | Other | NC | BCBS |
| 1115086015 | Other | NC | CIGNA |
| 480017899 | Other | NC | RAILROAD MEDICARE |
| 7908064 | Medicaid | NC | |
| 16437 | Other | NC | PARTNERS |
| 561412156 | Other | NC | HUMANA |
| 4279205 | Other | NC | AETNA |
| 440912 | Other | NC | OPTIMUM CHOICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050713000575 | NC | Practitioner - Podiatry | 1658307475 | Practice locations: Chapel Hill, NC |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 154 | NC | MD | Driving and Community Mobility Occupational Therapist |
Interoperability endpoints
- drbrucefawcett@cfaac-nc.direct.office.nextgen.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Primary Podiatric Medicine Podiatrist
- Raleigh, NC
- NPI 1720252026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459728000000",
"number": "1336238336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1514 GLENWOOD AVENUE",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276082368",
"telephone_number": "919-829-0076",
"fax_number": "919-836-9094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1514 GLENWOOD AVE",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276082368",
"telephone_number": "919-829-0076",
"fax_number": "919-836-9094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAWCETT",
"first_name": "BRUCE",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2016-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NC",
"license": "154",
"primary": true
},
{
"code": "213EP0504X",
"taxonomy_group": "",
"desc": "Podiatrist, Public Medicine",
"state": "NC",
"license": "154",
"primary": false
},
{
"code": "213EP1101X",
"taxonomy_group": "",
"desc": "Podiatrist, Primary Podiatric Medicine",
"state": "NC",
"license": "154",
"primary": false
},
{
"code": "213ER0200X",
"taxonomy_group": "",
"desc": "Podiatrist, Radiology",
"state": "NC",
"license": "154",
"primary": false
},
{
"code": "213ES0000X",
"taxonomy_group": "",
"desc": "Podiatrist, Sports Medicine",
"state": "NC",
"license": "154",
"primary": false
},
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "NC",
"license": "154",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED",
"identifier": "2751610",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "08064",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1115086015",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480017899",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7908064",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS",
"identifier": "16437",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "561412156",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4279205",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMUM CHOICE",
"identifier": "440912",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.