Maria C Petty, NURSE PRACTITIONER

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

NP020610 Issued in OH

Practice address

35000 Kaiser CT
Willoughby, OH 44094-3382

Phone

(440) 269-4600

Fax

(216) 229-6017

NPI assigned

Nov 15, 2011

Last updated

Jul 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Absolute Outcomes, LLC

  • Internal Medicine Physician
  • Monroe, CT
  • NPI 1073746202
  NPD (past)
• Keystone Hospice

  dba KeystoneCare Palliative Care Program

  • Internal Medicine Physician
  • Wyndmoor, PA
  • NPI 1912285198
  NPD (past)

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

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1114204419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35000 KAISER CT",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440943382",
            "telephone_number": "440-269-4600",
            "fax_number": "216-229-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35000 KAISER CT",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440943382",
            "telephone_number": "440-269-4600",
            "fax_number": "216-229-6017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "MARIA",
        "middle_name": "C",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-15",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CT",
            "license": "004979",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MA",
            "license": "RN2290435",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "NP020610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William J Petraiuolo, MD
• Pamela Petro, NP-C
• Andjelija Petrovic
• Michele Elizabeth Petruccelli
• Kristin Petruziello, CNP
• Jill K. Peysha
• Lydia Pfeifle, LMT
• Phillip W Wallace DDS Inc
• Amanda Ann Phillips, PT
• Phoenix Counseling and Wellness, LLC

• Primary Care Nurse Practitioner in Willoughby, OH
• Providers in Willoughby, OH by specialty
• Primary Care Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.