Individual provider Active NPI

Kyle J Fecteau

  • Acute Care Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1811652480
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
269868 Issued in AZ
Practice address
1305 N Martin Ave
Tucson, AZ 85721-7505
Phone
(520) 626-3808
NPI assigned
Nov 8, 2021
Last updated
Feb 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 269868 AZ Primary
Registered Nurse 163W00000X RN192626 AZ
Critical Care Medicine Registered Nurse 163WC0200X 12743151 AZ

Addresses

Primary practice location

1305 N Martin Ave
Tucson, AZ 85721-7505

Mailing address

7881 W School Hill PL
Tucson, AZ 85743-7505
Phone (520) 343-9140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20220209000513 AZ Practitioner - Nurse Practitioner 6305239666 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner-University Medical GroupGroup PAC ID 7719899871, 1,066 clinicians

Practice addresses (Care Compare)

1625 N Campbell Ave
Tucson, AZ 85719-4330
Phone (520) 694-0111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.34 of 100Reported as apm
Quality
74.56
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
12743151AZMDCritical Care Medicine Registered Nurse
269868AZMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest HBP Medical Services LLC Nurse Practitioner CurrentSince Apr 15, 2022 Accepting new patients
Banner-University Medical Group Current Accepting new patients
App of Southern Arizona HM LLC CurrentSince Feb 3, 2022 Accepting new patients
Banner-University Medical Group CurrentSince Jun 19, 2023 Accepting new patients
Banner-University Medical Group CurrentSince Jun 19, 2023 Accepting new patients

Locations

1551 E Tangerine Rd
Oro Valley, AZ 85755
Phone (520) 901-3500

1625 N Campbell Ave
Tucson, AZ 85719

2800 E Ajo Way
Tucson, AZ 85713
Phone (520) 294-4471

3838 N Campbell Ave
Bldg 2
Tucson, AZ 85719

6200 N La Cholla Blvd
Tucson, AZ 85741
Phone (520) 229-2657

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1636329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1811652480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7881 W SCHOOL HILL PL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857437505",
            "telephone_number": "520-343-9140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 N MARTIN AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857217505",
            "telephone_number": "520-626-3808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FECTEAU",
        "first_name": "KYLE",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-08",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "269868",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN192626",
            "primary": false
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "AZ",
            "license": "12743151",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.