Individual provider Active NPI

Bryce Fortner

  • Dentist
  • Spokane Valley, WA
National Provider Identifier
1730441965
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE60293867 Issued in WA
Practice address
1502 N Vercler Rd
Spokane Valley, WA 99216-1078
Phone
(509) 444-8200
Fax
(509) 232-2938
NPI assigned
Jun 13, 2012
Last updated
May 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE60293867 WA Primary

Addresses

Primary practice location

1502 N Vercler Rd
Spokane Valley, WA 99216-1078

Mailing address

611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161101000582 WA Order and Referring Only - DentistPractitioner - Dentist 3274811963

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE60293867WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Association of Spokane Dentist Past Accepting new patients
Community Health Association of Spokane Dentist Past Accepting new patients
Community Health Association of Spokane Past Accepting new patients
Community Health Association of Spokane Past Accepting new patients
Community Health Association of Spokane Dentist Past Accepting new patients
Community Health Association of Spokane Past Accepting new patients
Community Health Association of Spokane Dentist Past Accepting new patients
Community Health Association of Spokane Past Accepting new patients
Community Health Association of Spokane Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: bryce.fortner.1@11411.direct.athenahealth.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1730441965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888",
            "fax_number": "509-444-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 N VERCLER RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161078",
            "telephone_number": "509-444-8200",
            "fax_number": "509-232-2938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTNER",
        "first_name": "BRYCE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-13",
        "last_updated": "2022-05-03",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60293867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

Verify at the official NPI Registry.