Active NPI
Paul J Fetterly, MD, FACOG
- Family Medicine Physician
- Devils Lake, ND
National Provider Identifier
1801895610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 7419
- Practice address
- 1001 7TH St NE
Devils Lake, ND 58301-2719 - Phone
- (701) 662-2157
- Fax
- (701) 662-4116
- NPI assigned
- Jul 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 7419 | ND | Primary |
Addresses
Primary practice location
1001 7TH St NE
Devils Lake, ND 58301-2719
Mailing address
PO Box 1100
Devils Lake, ND 58301-1100
Phone (701) 662-2157
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18821 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinic Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Retail Pharmacy
- Devils Lake, ND
- NPI 1184718876
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395360000000",
"number": "1801895610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1100",
"city": "DEVILS LAKE",
"state": "ND",
"postal_code": "583011100",
"telephone_number": "701-662-2157",
"fax_number": "701-662-4116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 7TH ST NE",
"city": "DEVILS LAKE",
"state": "ND",
"postal_code": "583012719",
"telephone_number": "701-662-2157",
"fax_number": "701-662-4116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTERLY",
"first_name": "PAUL",
"middle_name": "J",
"credential": "MD, FACOG",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-14",
"last_updated": "2014-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ND",
"license": "7419",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18821",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Devils Lake, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.