Individual provider Active NPI

Bruce M Footit, MD

  • Internal Medicine Physician
  • Fairbanks, AK
National Provider Identifier
1760602866
Registry record updated Oct 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5031 Issued in AK
Practice address
1650 Cowles St
Fairbanks, AK 99701-5999
Phone
(907) 458-5178
Fax
(907) 458-5180
NPI assigned
Apr 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5031 AK Primary

Addresses

Primary practice location

1650 Cowles St
Fairbanks, AK 99701-5999

Mailing address

1001 Noble St
Fairbanks, AK 99701-4922
Phone (907) 459-3500

Other identifiers 1

IdentifierTypeStateIssuer
1018156MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040825000406 AK Practitioner - Internal Medicine 2264406271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York Medical College, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanana Valley Clinic LLCGroup PAC ID 5698056901, 142 clinicians

Practice addresses (Care Compare)

1650 Cowles St
Fairbanks, AK 99701-5907
Phone (907) 459-3500

Hospital & facility affiliations

  • Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012

Merit-based Incentive Payment System (MIPS)

Final score
92.86 of 100Reported as group
Quality
94.88
Promoting interoperability
100
Improvement activities
40
Cost
79.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy62
Upper gastrointestinal (GI) endoscopy for acid reflux68

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5031AKMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanana Valley Clinic LLC CurrentSince Jan 1, 2017 Accepting new patients
Tanana Valley Clinic LLC CurrentSince Jan 1, 2017 Accepting new patients
Northern Hospital Associates LLC Past Accepting new patients
Fairbanks Memorial Hospital, LLC Past Accepting new patients

Locations

1650 Cowles St
Fairbanks, AK 99701
Phone (907) 452-8181

1919 Lathrop St
Fairbanks, AK 99701
Phone (907) 459-3570

1650 Cowles St
Fl 4
Fairbanks, AK 99701

1001 Noble St
Fairbanks, AK 99701
Phone (907) 276-2806

Interoperability endpoints

  • Direct secure messaging: bruce.footit@foundationhealth.cernerdirect.com

Organizations & group practices 4

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 1

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": "1177891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477612800000",
    "number": "1760602866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 NOBLE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014922",
            "telephone_number": "907-459-3500",
            "fax_number": "907-459-3532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015999",
            "telephone_number": "907-458-5178",
            "fax_number": "907-458-5180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOOTIT",
        "first_name": "BRUCE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-30",
        "last_updated": "2016-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AK",
            "license": "5031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018156",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.