Individual provider Active NPI

Jocelyn Rose Pettitt, O.D.

  • Optometrist
  • Mentor, OH
National Provider Identifier
1093971533
Registry record updated May 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5814 Issued in OH
Practice address
7200 Mentor Ave
Mentor, OH 44060-7522
Phone
(440) 946-8809
Fax
(440) 269-7942
NPI assigned
Aug 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5814 OH Primary

Addresses

Primary practice location

7200 Mentor Ave
Mentor, OH 44060-7522

Mailing address

7200 Mentor Ave
Mentor, OH 44060-7522
Phone (440) 946-8809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101108000181 OH Practitioner - Optometry 5092900852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeg Ohio Professional PCGroup PAC ID 7618207036, 80 clinicians

Practice addresses (Care Compare)

7200 Mentor Ave
Mentor, OH 44060-7522
Phone (440) 946-8809

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Ohio Professional PC Optometrist CurrentSince Apr 9, 2021 Accepting new patients
Aeg Ohio Professional PC Optometrist CurrentSince Apr 9, 2021 Accepting new patients

Locations

7200 Mentor Ave
Mentor, OH 44060
Phone (440) 946-8809

7200 Mentor Ave
Ste A
Mentor, OH 44060
Phone (440) 946-0009

77 Normandy Dr
Painesville, OH 44077
Phone (440) 352-0616

33541 Aurora Rd
Solon, OH 44139
Phone (440) 248-2020

Organizations & group practices 2

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": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1093971533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 MENTOR AVE",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440607522",
            "telephone_number": "440-946-8809",
            "fax_number": "440-269-7942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 MENTOR AVE",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440607522",
            "telephone_number": "440-946-8809",
            "fax_number": "440-269-7942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTITT",
        "first_name": "JOCELYN",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-04",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.