Johanna Christine Pettrey, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP01151 Issued in NM

Practice address

1515 W Fir St
Portales, NM 88130-5703

Phone

(575) 356-6695

NPI assigned

Nov 7, 2005

Last updated

Apr 24, 2024By the provider in NPPES

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in NM

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

Nurse Practitioner

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

La Casa de Buena Salud IncGroup PAC ID 9234032939, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Roosevelt General Hospital Hospital, Portales, NM, CCN 320084
• Plains Regional Medical Center Hospital, Clovis, NM, CCN 320022

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: johanna.pettrey@363238321553412.direct.elationemr.com

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.

• La Casa de Buena Salud Inc.

  dba La Casa Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Portales, NM
  • NPI 1972603165
  Medicare reassignment Care Compare group NPD
• La Casa de Buena Salud Inc

  dba La Casa Community Behavioral Health Services

  • Community/Behavioral Health Agency
  • Roswell, NM
  • NPI 1538555040
  NPD
• La Casa de Buena Salud Inc

  dba La Casa School Based Clinic

  • Federally Qualified Health Center (FQHC)
  • Clovis, NM
  • NPI 1760788137
  NPD
• Clovis Family Health Care Center LLC

  • Family Medicine Physician
  • Clovis, NM
  • NPI 1760123475
  NPD (past)
• La Casa de Buena Salud Inc

  dba La Casa Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Roswell, NM
  • NPI 1215037379
  NPD (past)

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

• Presbyterian Healthcare Services

  dba Plains Regional Medical Center

  • Rural Acute Care Hospital
  • Clovis, NM
  • NPI 1629053509
  Care Compare affiliation
• Roosevelt County Special Hospital District

  dba Roosevelt General Hospital

  • General Acute Care Hospital
  • Portales, NM
  • NPI 1073517058
  Care Compare affiliation

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1265413447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 W 21ST ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014154",
            "telephone_number": "575-935-9000",
            "fax_number": "575-935-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 W FIR ST",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881305703",
            "telephone_number": "575-356-6695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTREY",
        "first_name": "JOHANNA",
        "middle_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "R47083",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0001144582",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "CNP01151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G7157",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Max Pena
• Amanda Marie Pendleton
• Yoon Shin Pennington
• Elizabeth Jane Pepper
• Jordyn Peralta, RBT
• Tori Lynn Peychich
• Jaren Ann Piepkorn
• Nathania Pierre
• Monica Rose Romero Plew, P.T.
• Tricia Elizabeth Poindexter

• Family Nurse Practitioner in Portales, NM
• Providers in Portales, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; 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.