Active NPI
Raena M. Pettitt, D.O.
- Family Medicine Physician
- Lynchburg, VA
National Provider Identifier
1124025085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0102201453
- Practice address
- 2321 Wards Rd
Lynchburg, VA 24502-2101 - Phone
- (434) 582-2273
- Fax
- (434) 582-1363
- NPI assigned
- Jul 6, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0102201453 | VA | Primary |
Addresses
Primary practice location
2321 Wards Rd
Lynchburg, VA 24502-2101
Mailing address
2321 Wards Rd
Lynchburg, VA 24502-2101
Phone (434) 582-2273
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010215048 | Medicaid | VA | |
| 203639329013 | Other | TRICARE PROVIDER NUMBER | |
| 010215048 | Other | VA PREMIER PROVIDER NUMBE | |
| 186414 | Other | ANTHEM PROVIDER NUMBER | |
| 203639329 | Other | PCHP PROVIDER NUMBER | |
| D5084 | Other | MEDCOST PROVIDER NUMBER | |
| 2379390 | Other | CIGNA PROVIDER NUMBER | |
| 78660 | Other | SENTARA/OPTIMA PROVIDER N | |
| 203639329 | Other | UNITED HEALTHCARE PROVIDE | |
| 329088 | Other | SOUTHERN HEALTH PROVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102201453 | VA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474416000000",
"number": "1124025085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2321 WARDS RD",
"city": "LYNCHBURG",
"state": "VA",
"postal_code": "245022101",
"telephone_number": "434-582-2273",
"fax_number": "434-582-1363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2321 WARDS RD",
"city": "LYNCHBURG",
"state": "VA",
"postal_code": "245022101",
"telephone_number": "434-582-2273",
"fax_number": "434-582-1363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTITT",
"first_name": "RAENA",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-06",
"last_updated": "2016-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0102201453",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010215048",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE PROVIDER NUMBER",
"identifier": "203639329013",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA PREMIER PROVIDER NUMBE",
"identifier": "010215048",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "186414",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PCHP PROVIDER NUMBER",
"identifier": "203639329",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST PROVIDER NUMBER",
"identifier": "D5084",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PROVIDER NUMBER",
"identifier": "2379390",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SENTARA/OPTIMA PROVIDER N",
"identifier": "78660",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE PROVIDE",
"identifier": "203639329",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOUTHERN HEALTH PROVIDER",
"identifier": "329088",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lynchburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.