NPIMap

Organization Active NPI

Petty Orthopaedics PC

  • Orthopaedic Surgery Physician
  • Lebanon, TN
National Provider Identifier
1184683179
Registry record updated Sep 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PETTY ORTHOPAEDICS PC
Practice address
1616 W. Main St.
Suite 300
Lebanon, TN 37087
Phone
(615) 443-7374
Fax
(615) 443-5488
NPI assigned
Mar 20, 2006
Last updated
Sep 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2012

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

Authorized official

Name
Dr. Damon H Petty, MDNPI 1861452195
Title
Owner
Phone
(615) 443-7374

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

1616 W. Main St.
Suite 300
Lebanon, TN 37087

Mailing address

1616 W Main St Ste 300
Lebanon, TN 37087-3101
Phone (615) 443-7374

Other identifiers 3

IdentifierTypeStateIssuer
1861452195OtherTNMEDICARE NPI
3732245OtherTNMEDICARE PTAN
3732245MedicaidTN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1184683179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 W MAIN ST STE 300",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370873101",
            "telephone_number": "615-443-7374",
            "fax_number": "615-443-5488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 W. MAIN ST.",
            "address_2": "SUITE 300",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "37087",
            "telephone_number": "615-443-7374",
            "fax_number": "615-443-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTY ORTHOPAEDICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-20",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "DAMON",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-443-7374",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NPI",
            "identifier": "1861452195",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "3732245",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3732245",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.