Louis Pettygrove, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-09167 Issued in NC

Practice address

3949 Browning PL
Raleigh, NC 27609-6536

Phone

(919) 787-7411

NPI assigned

Sep 2, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wake Radiology Diagnostic Imaging Inc.Group PAC ID 5092611863, 66 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Johnston Health Hospital, Smithfield, NC, CCN 340090

Merit-based Incentive Payment System (MIPS)

Final score

94.8 of 100Reported as group

Quality

99.47

Improvement activities

40

Cost

83.62

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Wake Radiology Diagnostic Imaging Inc.

  • Diagnostic Radiology Physician
  • Raleigh, NC
  • NPI 1538123450
  Medicare reassignment Care Compare group
• Wake Radiology Consultants PA

  • Diagnostic Radiology Physician
  • Raleigh, NC
  • NPI 1285698126
  Medicare reassignment

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

• Johnston Health Services Corporation

  • General Acute Care Hospital
  • Smithfield, NC
  • NPI 1619911104
  Care Compare affiliation

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

{
    "created_epoch": "1567382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628726400000",
    "number": "1194373217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3949 BROWNING PL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096536",
            "telephone_number": "919-787-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3949 BROWNING PL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096536",
            "telephone_number": "919-787-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTYGROVE",
        "first_name": "LOUIS",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-02",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-09167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leatha Mae Lee Pettress, LCSW-A
• Samone Dorothy Pettus
• Terry Lewis Pettus I
• Karen Y Petty, DDS
• Sara Meehee Petty, PA-C
• Jasmine Marie Peyton
• Robert B Peyton, MD
• Thomas N. Pezdek, DDS
• Henry Paul Pfeifer
• Catherine Pfeiffer, CRNA

• Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.