NPIMap

Individual provider Active NPI

Michael James Pettit, MD

  • Diagnostic Radiology Physician
  • Fort Worth, TX
National Provider Identifier
1215013891
Registry record updated Aug 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
L4643 Issued in TX
Practice address
815 Pennsylvania Ave
Fort Worth, TX 76104-2224
Phone
(817) 321-0387
NPI assigned
Oct 27, 2006
Last updated
Aug 13, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X L4643 TX Primary

Addresses

Primary practice location

815 Pennsylvania Ave
Fort Worth, TX 76104-2224

Mailing address

816 W Cannon St
Fort Worth, TX 76104-3146
Phone (817) 321-0387

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040618000715 TX Practitioner - Diagnostic Radiology 9335124072 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Texas Medical School at San Antonio, 1999
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

1500 S Main St
Fort Worth, TX 76104-4917
Phone (817) 321-0937

4701 Bryant Irvin Rd N
Fort Worth, TX 76107-7627
Phone (817) 321-0404

800 W Magnolia Ave
Fort Worth, TX 76104-4611

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
L4543TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health Imaging Partners, LLC Diagnostic Radiology CurrentSince Jul 1, 2016 Accepting new patients
Health Imaging Partners, LLC Diagnostic Radiology CurrentSince Mar 2, 2016 Accepting new patients
Health Imaging Partners, LLC Diagnostic Radiology CurrentSince Jan 1, 2014 Accepting new patients
Health Imaging Partners, LLC Diagnostic Radiology CurrentSince Apr 1, 2017 Accepting new patients
Health Imaging Partners, LLC Diagnostic Radiology CurrentSince Apr 14, 2022 Accepting new patients
Health Imaging Partners LLC Diagnostic Radiology CurrentSince May 1, 2017 Accepting new patients
Health Imaging Partners, LLC Diagnostic Radiology CurrentSince Apr 1, 2017 Accepting new patients
Health Imaging Partners, LLC CurrentSince Dec 20, 2024 Accepting new patients
Radiology Associates of North Texas PA Diagnostic Radiology CurrentSince Sep 15, 2012 Accepting new patients
Radiology Associates of North Texas, PA Diagnostic Radiology CurrentSince Sep 15, 2012 Accepting new patients
Health Imaging Partners, LLC Diagnostic Radiology CurrentSince Oct 1, 2012 Accepting new patients
Imaging Consultants of Garland LLP Diagnostic Radiology Past Accepting new patients
Lone Star Radiology Services PLLC Diagnostic Radiology Past Accepting new patients
Clinical Care in Radiology Past Accepting new patients

Locations

17980 Dallas Pkwy
Ste 200
Dallas, TX 75287
Phone (972) 248-1303

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

815 Pennsylvania Ave
Ft Worth, TX 76104
Phone (817) 321-0300

816 W Cannon St
Ft Worth, TX 76104
Phone (817) 321-0312

2600 W Pleasant Run Rd
Lancaster, TX 75146
Phone (469) 297-5321

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344816000000",
    "number": "1215013891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 W CANNON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043146",
            "telephone_number": "817-321-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042224",
            "telephone_number": "817-321-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2012-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "L4643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.