Timothy Fetterman, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35-071569 Issued in OH

Practice address

18780 Bagley Rd Ste 104
Cleveland, OH 44130-3304

Phone

(440) 816-5950

NPI assigned

Dec 29, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 11

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Wright State University Boonshoft School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southwest General Medical Group IncGroup PAC ID 8527964550, 232 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southwest General Home Health Home health agency, Middleburg Heights, OH, CCN 367253
• Southwest General Health Center Hospital, Middleburg Heights, OH, CCN 360155
• Cleveland Clinic Hospital, Cleveland, OH, CCN 360180

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Southwest General Medical Group Inc

  • Internal Medicine Physician
  • Cleveland, OH
  • NPI 1134239676

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Southwest General Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Middleburg HTS, OH
  • NPI 1588393979
  NPD
• Clinic Regional Physicians LLC

  • Internal Medicine Physician
  • Beachwood, OH
  • NPI 1043470453

  Family Medicine

  NPD (past)
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  NPD (past)

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

• Southwest General Health Center

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1154353993
  Care Compare affiliation
• Southwest General Health Center

  • Home Health Agency
  • Fairview Park, OH
  • NPI 1598797334
  Care Compare affiliation
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Care Compare affiliation

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1427035583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638269",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636950",
            "telephone_number": "440-816-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18780 BAGLEY RD STE 104",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441303304",
            "telephone_number": "440-816-5950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27076 Bagley Road",
            "address_purpose": "LOCATION",
            "city": "Olmsted Township",
            "state": "OH",
            "postal_code": "44138",
            "country_code": "US",
            "telephone_number": "440-816-8380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FETTERMAN",
        "first_name": "TIMOTHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2022-06-03",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-071569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000198967",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CG4860",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "0105480",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0843940002",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2238199",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD CARE",
            "identifier": "P00478745",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0005168421",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "080176792",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUAL CHOICE",
            "identifier": "84779",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2001470",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD CARE",
            "identifier": "P00701420",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tfetterman@direct.swgeneral.com",
            "affiliation": "Y",
            "affiliationName": "Southwest General Medical Group, Inc.",
            "address_1": "18780 Bagley Rd Ste 104",
            "city": "Cleveland",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441303304",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tfetterman@direct.swgeneral.com",
            "affiliation": "Y",
            "affiliationName": "Southwest General Medical Group Inc",
            "address_1": "27076 Bagley Road",
            "city": "Olmsted Township",
            "state": "OH",
            "country_code": "US",
            "postal_code": "44138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gagandeep Fervaha, M.D.
• Jessica Rochelle Fesler, MD
• Bryce Anthony Fetterman
• Douglas Alexander Fetterman, MD
• Hallie E Fetterman, PHD, BCBA, COBA
• Shelley Lynn Fetzer, OT
• Jillian Tait Fetzner, NP-C
• George N Feyda, M.D.
• FHS Cedar, Inc.
• Lauren Elizabeth Fial

• Family Medicine Physician in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.