Jonathan Matthew Pettegrew, D.O.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

20A13395 Issued in CA

Practice address

609 E Orangeburg Ave
Suite 201
Modesto, CA 95350-5512

Phone

(209) 572-3224

Fax

(209) 572-4528

NPI assigned

Mar 10, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Orthopedic Surgery

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stanislaus Orthopaedic and Sports Medicine ClinicGroup PAC ID 0042373862, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Doctors Medical Center Hospital, Modesto, CA, CCN 050464
• Doctors Hospital of Manteca Hospital, Manteca, CA, CCN 050118

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Stanislaus Orthopaedic and Sports Medicine Clinic

  • Specialist
  • Modesto, CA
  • NPI 1669505160
  Medicare reassignment Care Compare group
• County of San Joaquin

  • General Acute Care Hospital
  • French Camp, CA
  • NPI 1801830583
  Medicare reassignment NPD
• County of Stanislaus

  • Clinic/Center
  • Turlock, CA
  • NPI 1831394998
  Medicare reassignment NPD
• San Joaquin Faculty Medical Group

  • Internal Medicine Physician
  • French Camp, CA
  • NPI 1225063761
  Medicare reassignment NPD
• County of San Joaquin

  • Multi-Specialty Clinic/Center
  • Manteca, CA
  • NPI 1417407636
  NPD
• County of Stanislaus

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1629094891
  NPD
• County of Stanislaus

  • Community/Behavioral Health Agency
  • Modesto, CA
  • NPI 1902765993
  NPD
• Doctors Hospital of Manteca, Inc.

  • General Acute Care Hospital
  • Manteca, CA
  • NPI 1992736599
  NPD (past)
• Physicians Surgery Center of Modesto LLC

  • Ambulatory Surgical Clinic/Center
  • Modesto, CA
  • NPI 1538280284
  NPD (past)

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

• Doctors Hospital of Manteca, Inc.

  • General Acute Care Hospital
  • Manteca, CA
  • NPI 1992736599
  Care Compare affiliation
• Doctors Medical Center of Modesto, Inc.

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1184654923
  Care Compare affiliation

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

{
    "created_epoch": "1236643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1053552745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 E ORANGEBURG AVE",
            "address_2": "SUITE 201",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505512",
            "telephone_number": "209-572-3224",
            "fax_number": "209-572-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 E ORANGEBURG AVE",
            "address_2": "SUITE 201",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505512",
            "telephone_number": "209-572-3224",
            "fax_number": "209-572-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTEGREW",
        "first_name": "JONATHAN",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-10",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "20A13395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet L Petrides, RNFA
• Nyssa Petriz
• Cheril Nicole Petroni
• Joseph Lido Petroni II, LMFT
• Ekaterina Nikolaevna Petrova, MD
• Clair L. Pettinger, MD
• Monique Pettis, M.A., ED.S., PPS
• Sofia Ekaterina Pettygrove
• Katherine Marcela Pettyjohn, FNP-BC
• Rosa Peverini, MD

• Sports Medicine (Orthopaedic Surgery) Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.