Peyton Rose Petty, MSW, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

33008990A Issued in IN

Practice address

3120 Suite B Windsor Court
Elkhart, IN 46514

Phone

(170) 085-5267

NPI assigned

Aug 9, 2021

Sex

Female

Sole proprietor

Yes

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

• Peyton Rose Coney Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932
  NPD

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1235804618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 CRIMSON LEAF DR",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266285",
            "telephone_number": "574-807-1158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 SUITE B WINDSOR COURT",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "46514",
            "telephone_number": "170-085-5267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "PEYTON",
        "middle_name": "ROSE",
        "credential": "MSW, LSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-09",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IN",
            "license": "33008990A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "33008990A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "http://mcarthurcounselingcenter.com/",
            "affiliation": "N",
            "address_1": "3120 Suite B Windsor Court",
            "city": "Elkhart",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PEYTON",
            "last_name": "CONEY",
            "middle_name": "ROSE",
            "credential": "MSW, LSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rodney Alan Perry Jr.
• Peter M. Carney, M.D. P.C.
• Cameron Peters
• Carol Diane Peters, RN, CDE
• Bridget Petersheim
• Pamela Lynn Pfail, LAT ATC
• Robert Larry Pfeil, PHD
• Amy M Phebus, PTA
• Chelsea Philpot
• Physical Therapy Professionals PC

• Social Worker in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.