Theron M Pettit, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD61603161 Issued in WA

Practice address

700 NE 87TH Ave
Vancouver, WA 98664-4896

Phone

(407) 864-3051

NPI assigned

Dec 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL, WA2 enrollments

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 2

Specialty

Internal Medicine

Education

Uniformed Services Uhs Fe Hebert School of Med, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth Southwest Home Health Home health agency, Vancouver, WA, CCN 507064
• Orlando Health Hospital, Orlando, FL, CCN 100006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tpettit26370@tvc-direct.org

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.

• The Vancouver Clinic Inc PS

  dba The Vancouver Clinic

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1992759427
  Medicare reassignment Care Compare group NPD
• Orlando Physicians Network Inc

  • Internal Medicine Physician
  • Orlando, FL
  • NPI 1568693554
  Medicare reassignment NPD
• The Vancouver Clinic Inc PS

  dba Salmon Creek 2 Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Vancouver, WA
  • NPI 1306556907
  NPD
• The Vancouver Clinic Pharmacy

  • Pharmacist
  • Vancouver, WA
  • NPI 1336365857
  NPD (past)

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

• Peacehealth

  dba Peacehealth Southwest Home Health

  • Home Health Agency
  • Vancouver, WA
  • NPI 1285720896
  Care Compare affiliation
• Orlando Health, Inc.

  • General Acute Care Hospital
  • Orlando, FL
  • NPI 1184709057
  Care Compare affiliation

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1245214279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4140 W 190TH ST FL 2",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905045513",
            "telephone_number": "818-990-1067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986644896",
            "telephone_number": "407-864-3051"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16030 Ventura Blvd Ste 680",
            "address_purpose": "LOCATION",
            "city": "Encino",
            "state": "CA",
            "postal_code": "914364443",
            "country_code": "US",
            "telephone_number": "818-990-1067",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "THERON",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61603161",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C175441",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME91576",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272039600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "64060",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angelika M Petrova
• Anna M Petruolo, LMP
• Danielle Mariah Pettet, DC
• Michael Pettet, DC
• Tyler Jonathon Pettett, LMHCA
• Daniel S Petty, DDS
• Tenli N Petty
• Christopher Pexton, D.O.
• Liliana Peychev
• David A Pfaff, M.D.

• Internal Medicine Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; 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.