Michael Dietrich Fetter, MS

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

11 N Main St
Randolph, VT 05060-1126

Phone

(802) 728-4466

Fax

(802) 728-4197

NPI assigned

Feb 23, 2024

Last updated

Feb 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Practice roles

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.

• Clara Martin Center

  • Community/Behavioral Health Agency
  • Randolph, VT
  • NPI 1548060015
  NPD (past)

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

{
    "created_epoch": "1708646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1972369387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 CAMBRIDGEVILLE DR UNIT 4",
            "city": "ENFIELD",
            "state": "NH",
            "postal_code": "037483160",
            "telephone_number": "603-345-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 N MAIN ST",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "050601126",
            "telephone_number": "802-728-4466",
            "fax_number": "802-728-4197"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39 Fogg Farm Rd",
            "address_purpose": "LOCATION",
            "city": "Wilder",
            "state": "VT",
            "postal_code": "050010506",
            "country_code": "US",
            "telephone_number": "802-728-4466 x243",
            "fax_number": "802-295-1312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FETTER",
        "first_name": "MICHAEL",
        "middle_name": "DIETRICH",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Beth Farnham, MA
• Laura Farrington, BA
• Erica Fayrie, LCMHC, LMHC, ATR
• Deena Feinberg, BA
• Danielle Ferry, LCMHC
• Steven J. Fisher, MD
• Dylan Fishman, BA
• Emilija O Florance, MD
• Penny Fossman, APRN, RN
• Elise Foster, BS

• Community Health Worker in Randolph, VT
• Providers in Randolph, VT by specialty
• Community Health Worker in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.