Individual provider Active NPI

Brian Fettner

  • Physical Therapist
  • Naples, FL
National Provider Identifier
1962893487
Registry record updated Jan 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
29997 Issued in FL
Practice address
1660 Medical Blvd Ste 200
Naples, FL 34110-1416
Phone
(239) 449-3072
Fax
(877) 334-1886
NPI assigned
Feb 6, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA01595500 NJ
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 29997 FL Primary

Addresses

Primary practice location

1660 Medical Blvd Ste 200
Naples, FL 34110-1416

Mailing address

1660 Medical Blvd Ste 200
Naples, FL 34110-1416
Phone (239) 449-3072

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150424001798 FL Practitioner - Physical Therapist in Private Practice 1850610809 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tom Segal Physical Therapy, Inc.Group PAC ID 3375736176, 5 clinicians

Practice addresses (Care Compare)

9045 La Fontana Blvd
Suite 113
Boca Raton, FL 33434-5640
Phone (561) 482-8007

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
29997FLMDPhysical Therapist
40QA01595500NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Neuroscience and Spine Associates PL Multi-Specialty CurrentSince Feb 17, 2015 Accepting new patients
Tom Segal Physical Therapy, Inc. Multi-Specialty CurrentSince Nov 14, 2019 Accepting new patients
Neuroscience and Spine Associates PL Multi-Specialty CurrentSince Feb 17, 2015 Accepting new patients
Neuroscience and Spine Associates PL Past Accepting new patients

Locations

9045 La Fontana Blvd
Ste 113
Boca Raton, FL 33434
Phone (561) 482-8007

6101 Pine Ridge Rd
Naples, FL 34119
Phone (239) 348-4000

1660 Medical Blvd
Ste 200
Naples, FL 34110
Phone (239) 566-3434

3451 Pine Ridge Rd
Ste 601
Naples, FL 34109

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.

NPI Registry JSON

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

{
    "created_epoch": "1423180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546473600000",
    "number": "1962893487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 MEDICAL BLVD STE 200",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341101416",
            "telephone_number": "239-449-3072",
            "fax_number": "877-334-1886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 MEDICAL BLVD STE 200",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341101416",
            "telephone_number": "239-449-3072",
            "fax_number": "877-334-1886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTNER",
        "first_name": "BRIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-06",
        "last_updated": "2019-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01595500",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "29997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naples, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.