NPIMap

Individual provider Active NPI

James C Pettit, DO

  • Family Medicine Physician
  • Rockdale, TX
National Provider Identifier
1265450175
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
F9947 Issued in TX
Practice address
1700 Brazos Ave
Rockdale, TX 76567-2517
Phone
(512) 446-4500
NPI assigned
Jul 18, 2006
Last updated
Jun 10, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X F9947 TX Primary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X F9947 TX

Addresses

Primary practice location

1700 Brazos Ave
Rockdale, TX 76567-2517

Mailing address

3721 Herwol Ave
Waco, TX 76710-7218

Other identifiers 3

IdentifierTypeStateIssuer
8U8772OtherTXBCBS
140233137MedicaidTX
140233138MedicaidTX

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
I20031106000619 TX Practitioner - Family Practice 8820901879 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F9947TXMDHospice and Palliative Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group PLLC CurrentSince Aug 12, 2017 Accepting new patients
Concord Medical Group of Texas PLLC CurrentSince Aug 12, 2017 Accepting new patients
SLP Jeffrey Place LLC Past Accepting new patients
Coryell County Memorial Hospital Authority Past Accepting new patients
Gentle Transitions, LLC Family Medicine PastSince Jul 10, 2022 Accepting new patients
Chambers County Public Hospital District No 1 Past Accepting new patients
MSL Meridian Past Accepting new patients
Winnie-Stowell Hospital District Past Accepting new patients
Texas Emergency Room Services , PA Past Accepting new patients

Locations

2500 E Main St
Alice, TX 78332
Phone (361) 664-4376

5900 Altamesa Blvd
Ft Worth, TX 76132
Phone (817) 433-9100

310 W South St
Henrietta, TX 76365
Phone (806) 647-2191

400 SW 25th Ave
Mineral Wells, TX 76067
Phone (940) 325-7891

520 E 6th St
Odessa, TX 79761
Phone (432) 332-0929

305 N McKinney St
Sweeny, TX 77480
Phone (979) 548-1500

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avir at Jeffrey PlaceWaco, TX, CCN 455489 Skilled nursing facility Adp of the SNF Oct 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402358400000",
    "number": "1265450175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 HERWOL AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767107218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 BRAZOS AVE",
            "city": "ROCKDALE",
            "state": "TX",
            "postal_code": "765672517",
            "telephone_number": "512-446-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "JAMES",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2014-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F9947",
            "primary": true
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "TX",
            "license": "F9947",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8U8772",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140233137",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140233138",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockdale, TX

Sources for this page

Verify at the official NPI Registry.