Daniel Fettig, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0006373 Issued in CO

Practice address

5387 Manhattan Cir Ste 201
Boulder, CO 80303-4283

Phone

(303) 494-2707

NPI assigned

Dec 15, 2021

Last updated

Dec 15, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in CO

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

Physician Assistant

Education

George Washington University School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Creekside Physical Medicine PLLCGroup PAC ID 1658373923, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: daniel.fettig.1@34007.direct.athenahealth.com

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.

• Creekside Physical Medicine PLLC

  • Neuromusculoskeletal Medicine & OMM Physician
  • Boulder, CO
  • NPI 1578601969
  Medicare reassignment Care Compare group
• Creekside Physical Medicine PLLC

  • Neuromusculoskeletal Medicine & OMM Physician
  • Longmont, CO
  • NPI 1972101202
  NPD

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

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1720747934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10449 GARLAND DR",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "800217355",
            "telephone_number": "303-653-4375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5387 MANHATTAN CIR STE 201",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803034283",
            "telephone_number": "303-494-2707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTIG",
        "first_name": "DANIEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-15",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "0006373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Harwood Ferguson
• Anna Fernandez
• Anna Fernbach
• Lenni Robin Ferren, NLC
• Jennifer Shaughnessy Ferris, DPT, CSCS
• Renate Ursula Fettig
• Lindsay Catherine Feuerborn
• Berkeley Fial, PA
• Cassandra Field, MA, LPC, CAC III
• Jojo H. Field, M.A., N.C.C.

• Physician Assistant in Boulder, CO
• Providers in Boulder, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; 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.