Individual provider Active NPI

Justen Pettigrew, M.D.

  • Emergency Medicine Physician
  • Wenatchee, WA
National Provider Identifier
1104206507
Registry record updated Jul 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD60836734 Issued in WA
Practice address
1201 S Miller St
Wenatchee, WA 98801
Phone
(509) 662-1511
NPI assigned
Jun 2, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD60836734 WA Primary

Addresses

Primary practice location

1201 S Miller St
Wenatchee, WA 98801

Mailing address

1201 S Miller St
Wenatchee, WA 98801-3201
Phone (509) 662-1511

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20180427000249 WA Practitioner - Emergency Medicine 6204148117 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Louisville School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Washington Health Services AssociationGroup PAC ID 4880504596, 708 clinicians

Practice addresses (Care Compare)

1201 S Miller St
Wenatchee, WA 98801-3201
Phone (509) 662-2208

Hospital & facility affiliations

  • Confluence Health Hospital Hospital, Wenatchee, WA, CCN 500016

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60836734WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wenatchee Valley Hospital Current Accepting new patients
Central Washington Health Services Association Current Accepting new patients

Locations

17 S Western Ave
Tonasket, WA 98855
Phone (509) 486-2174

1201 S Miller St
Wenatchee, WA 98801
Phone (509) 662-2208

820 N Chelan Ave
Wenatchee, WA 98801
Phone (509) 863-4868

933 Red Apple Rd
Wenatchee, WA 98801
Phone (509) 655-6125

Interoperability endpoints

  • Direct secure messaging: jpettigrew60350@edirect.chehr.org

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1104206507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 S MILLER ST",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988013201",
            "telephone_number": "509-662-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S MILLER ST",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "98801",
            "telephone_number": "509-662-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIGREW",
        "first_name": "JUSTEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-02",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD60836734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wenatchee, WA

Sources for this page

Verify at the official NPI Registry.