Jillian Tait Fetzner, NP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

COA16124 Issued in OH

Practice address

10685 Carnegie Ave
Cleveland, OH 44106

Phone

(216) 445-7634

Fax

(216) 444-3474

NPI assigned

Nov 5, 2014

Sex

Female

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 1

Other names 1

• Jillian Tait Johnson Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

University Hospitals Medical Group IncGroup PAC ID 4789682493, 2,248 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.19 of 100Reported as group

Quality

63.13

Promoting interoperability

100

Improvement activities

40

Cost

74.18

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jfetzner27805@ehrdirect.uhhospitals.org

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.

• University Hospitals Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Cleveland, OH
  • NPI 1669499414
  Medicare reassignment Care Compare group NPD
• Multicare Health System

  dba Pacific Sports Medicine @ MultiCare

  • Nurse Practitioner
  • Tacoma, WA
  • NPI 1407808413
  NPD (past)

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

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550188800000",
    "number": "1588060321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10685 CARNEGIE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44106",
            "telephone_number": "216-445-7634",
            "fax_number": "216-444-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10685 CARNEGIE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44106",
            "telephone_number": "216-445-7634",
            "fax_number": "216-444-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETZNER",
        "first_name": "JILLIAN",
        "middle_name": "TAIT",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-05",
        "last_updated": "2019-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "COA16124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0115025",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILLIAN",
            "last_name": "JOHNSON",
            "middle_name": "TAIT",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bryce Anthony Fetterman
• Douglas Alexander Fetterman, MD
• Hallie E Fetterman, PHD, BCBA, COBA
• Timothy Fetterman, MD
• Shelley Lynn Fetzer, OT
• George N Feyda, M.D.
• FHS Cedar, Inc. (The Gardens of Fairfax Health Care Center)
• Lauren Elizabeth Fial
• Sydney Fiala, LSW
• Brenda Fialko

• Adult Health Nurse Practitioner in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Adult Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; 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.