Gretchen G Petterway, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD.202577 Issued in LA

Practice address

9220 Ellerbe Rd
Suite 700
Shreveport, LA 71106-6739

Phone

(318) 681-5282

Fax

(318) 681-5284

NPI assigned

May 24, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gretchen Gillyard Former name

Medicare fee-for-service enrollment

Enrolled in LA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4

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.

• C H Wilkinson Physician Network

  • Family Medicine Physician
  • Irving, TX
  • NPI 1457382947

  LA, Pediatrics

  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225

  LA, Pediatrics

  Medicare reassignment NPD
• C H Wilkinson Physician Network

  • Orthopaedic Surgery Physician
  • Corpus Christi, TX
  • NPI 1750826095
  NPD
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• Mid City Pediatrics

  • Pediatrics Physician
  • Shreveport, LA
  • NPI 1902811888
  NPD (past)
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572
  NPD (past)

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483315200000",
    "number": "1174734818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 HIDDEN RDG",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750383813",
            "telephone_number": "469-282-2711",
            "fax_number": "469-282-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9220 ELLERBE RD",
            "address_2": "SUITE 700",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711066739",
            "telephone_number": "318-681-5282",
            "fax_number": "318-681-5284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERWAY",
        "first_name": "GRETCHEN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-24",
        "last_updated": "2017-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD.202577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1079219",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRETCHEN",
            "last_name": "GILLYARD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Murray Evelyn Petersen, MD
• Peterson Counseling Services, LLC
• Claire Ainsley Peterson
• Joyce Peterson
• Tanganyika Peterson
• Dejuana Lachelle Danzell Petteway, LCSW, ASCW, ACHP-SW
• Kyrenda Petty
• Tanner Petty
• Barbara Peyton
• Linh Pham

• Pediatrics Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2017; 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.