Carl Anthony Petitto, OT/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

0107001 Issued in NY

Practice address

22567 Summit Dr BLDG 2
Watertown, NY 13601-7210

Phone

(315) 779-6784

Fax

(315) 779-6799

NPI assigned

Dec 22, 2005

Sex

Male

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 3

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Samaritan Medical Practice PCGroup PAC ID 5698853133, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cpetitto@samaritanmedicalpractice.medentdirect.com

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.

• Samaritan Medical Practice, PC

  • Surgery Physician
  • Watertown, NY
  • NPI 1124202619
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657065600000",
    "number": "1245217066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22567 SUMMIT DR BLDG 2",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136017210",
            "telephone_number": "315-779-6784",
            "fax_number": "315-779-6799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22567 SUMMIT DR BLDG 2",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136017210",
            "telephone_number": "315-779-6784",
            "fax_number": "315-779-6799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21101 State Route 12F",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Watertown",
            "state": "NY",
            "postal_code": "136011078",
            "country_code": "US",
            "telephone_number": "315-782-0440",
            "fax_number": "315-782-5349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETITTO",
        "first_name": "CARL",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "OT/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "0107001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID",
            "identifier": "02163660",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GR MEDICARE",
            "identifier": "BA0113",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02562729",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Perry Optical (Vision Center II)
• Jennifer Nadine Perry, CRNA
• Marie Petell, LPN
• Lisa Ann Peters
• Jill Christine Peterson, DO
• Michael B Peyser, MD
• Sirina Phelps
• Tara Phillips-McAuliffe, LCSW-R
• Andrea Lynn Phillips, M.A., CCC-SLP
• Lila Phillips

• Occupational Therapist in Watertown, NY
• Providers in Watertown, NY by specialty
• Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.