NPIMap

Individual provider Active NPI

Brandon Fetterolf, D.O.

  • Emergency Medicine Physician
  • Tacoma, WA
National Provider Identifier
1679815195
Registry record updated Mar 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2017-01929 Issued in NC
Practice address
Madigan Army Medical Center
9040 Fitzsimmons Dr
Tacoma, WA 98431
Phone
(989) 859-3260
NPI assigned
Mar 22, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2017-01929 NC Primary

Addresses

Primary practice location

Madigan Army Medical Center
9040 Fitzsimmons Dr
Tacoma, WA 98431

Mailing address

Madigan Army Medical Center
9040 Fitzsimmons Dr
Tacoma, WA 98431
Phone (989) 859-3260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180416000552 NC Practitioner - Emergency Medicine 2769798966 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Osteopathic Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians
Wake Forest Emergency ProvidersGroup PAC ID 7012819816, 497 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

3536 Mt Holly Huntersville Rd
Charlotte, NC 28216-8644
Phone (336) 716-2255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
98.67
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Ballantyne Emergency Physicians PLLC Emergency Medicine CurrentSince Jan 28, 2022 Accepting new patients
The Carolinas Emergency Group, PLLC Emergency Medicine CurrentSince Jan 20, 2022 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Wake Forest Emergency Providers CurrentSince Jan 11, 2022 Accepting new patients
Stallings Emergency Physicians, PLLC Emergency Medicine CurrentSince Jan 20, 2022 Accepting new patients
Carolinas Medical Center CurrentSince Aug 13, 2018 Accepting new patients
Ballantyne Emergency Physicians PLLC Emergency Medicine CurrentSince Jan 28, 2022 Accepting new patients
Carolinas Medical Center Emergency Medicine CurrentSince Aug 13, 2018 Accepting new patients

Locations

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

16035 Johnston Rd
Charlotte, NC 28277
Phone (704) 542-5132

11516 Providence Rd
Charlotte, NC 28277
Phone (704) 667-0370

3536 Mt Holly Huntersville Rd
Charlotte, NC 28216
Phone (704) 801-6500

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1000 Healing Way
Matthews, NC 28104
Phone (800) 821-1535

600 Hospital Dr
Monroe, NC 28112
Phone (704) 283-3100

2700 S Providence Rd
Waxhaw, NC 28173
Phone (704) 243-2254

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 8

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1363910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520380800000",
    "number": "1679815195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MADIGAN ARMY MEDICAL CENTER",
            "address_2": "9040 FITZSIMMONS DR",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98431",
            "telephone_number": "989-859-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MADIGAN ARMY MEDICAL CENTER",
            "address_2": "9040 FITZSIMMONS DR",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98431",
            "telephone_number": "989-859-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTEROLF",
        "first_name": "BRANDON",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-22",
        "last_updated": "2018-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2017-01929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.