Thomas Maxwell Fissenden, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

DR.0056808 Issued in CO

Practice address

5881 W 16TH St
Greeley, CO 80634-2910

Phone

(970) 313-2740

Fax

(970) 313-2744

NPI assigned

Apr 21, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, ND2 enrollments

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 2

Specialty

Otolaryngology

Education

Drexel University College of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health Hospital, Fargo, ND, CCN 350070
• Essentia Health St Marys - Detroit Lakes Hospital, Detroit Lakes, MN, CCN 240101

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Innovis Health, LLC

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463
  Medicare reassignment Care Compare group NPD
• Altru Health System

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552

  Family Medicine

  Medicare reassignment NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment NPD
• Altru Health System

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315
  NPD
• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161
  NPD
• Innovis Health LLC

  • Multi-Specialty Clinic/Center
  • Fargo, ND
  • NPI 1144776576

  Family Medicine

  NPD
• Innovis Health LLC

  • Occupational Medicine Clinic/Center
  • Fargo, ND
  • NPI 1568918902

  Family Medicine

  NPD
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• Bass Medical Group

  • Specialist
  • Walnut Creek, CA
  • NPI 1154401941
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Innovis Health, LLC

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463
  Care Compare affiliation
• St Mary'S Regional Health Center

  • Rural Health Clinic/Center
  • Frazee, MN
  • NPI 1902364482

  Hospital

  Care Compare affiliation
• St Marys Regional Health Center

  • Rural Health Clinic/Center
  • Park Rapids, MN
  • NPI 1730706656

  Hospital

  Care Compare affiliation
• St. Marys Regional Health Center

  • Rural Acute Care Hospital
  • Detroit Lakes, MN
  • NPI 1679561088
  Care Compare affiliation

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

{
    "created_epoch": "1303344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1851682090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5881 W 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806342910",
            "telephone_number": "970-313-2740",
            "fax_number": "970-313-2744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5881 W 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806342910",
            "telephone_number": "970-313-2740",
            "fax_number": "970-313-2744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISSENDEN",
        "first_name": "THOMAS",
        "middle_name": "MAXWELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-21",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "ND",
            "license": "18530",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CO",
            "license": "DR.0056808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "thomasfissenden@sjhhandhmg.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "500 Doyle Park Dr Ste 106",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954054559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Finni Optical Company Inc
• Kenneth William Fischer, OTR/L
• Madeline Jean Fish, OTD, OTR/L
• Isaac Webster Fisher, SLP-CF
• Thomas Charles Fisher, M.D.
• David J Fitzgerald, D.O.
• Erica Robin Bley Fitzgerald, NP-C
• Sean Patrick Fitzgerald, MSN FNP-C
• Courtnay Flagg
• Kaylin Flaherty

• Otolaryngology Physician in Greeley, CO
• Providers in Greeley, CO by specialty
• Otolaryngology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.