Individual provider Active NPI

Timothy Taylor Hobbes Fetterman

  • Certified Registered Nurse Anesthetist
  • Greenville, SC
National Provider Identifier
1649809088
Registry record updated Jan 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
23934 Issued in SC
Practice address
701 Grove Rd
Greenville, SC 29605-4210
Phone
(864) 455-3076
NPI assigned
Apr 7, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Certified Registered Nurse Anesthetist 367500000X 23934 SC Primary

Addresses

Primary practice location

701 Grove Rd
Greenville, SC 29605-4210

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 797-6220

Other practice location 1

7 Independence Pt Ste 300
Greenville, SC 29615-4569
Phone (864) 522-3700

Other identifiers 1

IdentifierTypeStateIssuer
AN3707MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200616001303 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 4284056557 Reassigns benefits to 3 organizations
I20230908003307 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 4284056557 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health University Medical GroupGroup PAC ID 8325950983, 2,467 clinicians
Anmed HealthGroup PAC ID 1951215243, 348 clinicians

Practice addresses (Care Compare)

300 E McBee Ave
Greenville, SC 29601-2842
Phone (864) 797-6220

300 E McBee Ave FL
Suite 4
Greenville, SC 29601-2842

67 Creekside Park CT
Greenville, SC 29615-4810
Phone (864) 522-3700

701 Grove Rd
Greenville, SC 29605-4210

800 N Fant St
Anderson, SC 29621-5708
Phone (864) 512-3076

Hospital & facility affiliations

  • Prisma Health Greenville Memorial Hospital Hospital, Greenville, SC, CCN 420078
  • Anmed Health Hospital, Anderson, SC, CCN 420027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
7228NCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Anmed Health Nurse Anesthetist, Certified Registered CurrentSince Apr 7, 2025 Accepting new patients
Diagnostic Radiology of Anderson, P.a. Current Accepting new patients
Anmed Health CurrentSince Apr 7, 2025 Accepting new patients
Prisma Health University Medical Group CurrentSince Jan 1, 2022 Accepting new patients
Anmed Health Nurse Anesthetist, Certified Registered Current Accepting new patients
Prisma Health University Medical Group CurrentSince Jan 1, 2022 Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Pathology Associates of Greenville PA Current Accepting new patients
Prisma Health-Upstate Current Accepting new patients
Medstream Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Aug 28, 2023 Accepting new patients
Prisma Health-Upstate CurrentSince Jun 8, 2020 Accepting new patients

Locations

800 N Justice St
Hendersonvlle, NC 28791
Phone (828) 696-1000

830 Rockford St
Mount Airy, NC 27030
Phone (336) 719-7000

800 N Fant St
Anderson, SC 29621
Phone (864) 512-1000

2000 E Greenville St
Anderson, SC 29621
Phone (864) 512-1000

22725 US Highway 76
Clinton, SC 29325
Phone (864) 833-9100

200 Fleetwood Dr
Easley, SC 29640
Phone (864) 442-7200

175 Patewood Dr
Greenville, SC 29615
Phone (864) 797-1000

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

7 Independence Pt
Ste 300
Greenville, SC 29615
Phone (864) 522-3700

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

67 Creekside Park Ct
Greenville, SC 29615
Phone (864) 242-4602

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

830 S Buncombe Rd
Greer, SC 29650
Phone (864) 797-8000

298 Memorial Dr
Seneca, SC 29672
Phone (864) 482-3100

729 SE Main St
Simpsonville, SC 29681
Phone (864) 271-8647

1413 John B White SR Blvd
Ste D
Spartanburg, SC 29306
Phone (864) 587-5768

807 N Main St
Travelers Rst, SC 29690
Phone (864) 834-5132

Organizations & group practices 11

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.

Hospital & facility affiliations 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641513600000",
    "number": "1649809088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-797-6220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054210",
            "telephone_number": "864-455-3076"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7 Independence Pt Ste 300",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296154569",
            "country_code": "US",
            "telephone_number": "864-522-3700",
            "fax_number": "864-522-3705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FETTERMAN",
        "first_name": "TIMOTHY",
        "middle_name": "TAYLOR HOBBES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-07",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "23934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AN3707",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.