NPIMap

Individual provider Active NPI

Trent Leon Pettijohn, MD

  • Interventional Cardiology Physician
  • Plano, TX
National Provider Identifier
1265468706
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
J4433 Issued in TX
Practice address
6300 W Parker Rd
Mob II 125
Plano, TX 75093-8100
Phone
(469) 800-4400
Fax
(469) 800-4410
NPI assigned
Jun 25, 2006
Last updated
Jan 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X J4433 TX
Cardiovascular Disease Physician 207RC0000X J4433 TX
Interventional Cardiology Physician 207RI0011X J4433 TX Primary
Nuclear Medicine Physician 207U00000X J4433 TX
Nuclear Cardiology Physician 207UN0901X J4433 TX

Addresses

Primary practice location

6300 W Parker Rd
Mob II 125
Plano, TX 75093-8100

Mailing address

6300 W Parker Rd
Mob II 125
Plano, TX 75093-8100
Phone (469) 800-4400

Other identifiers 5

IdentifierTypeStateIssuer
8CX370OtherTXBCBSTX
036498604MedicaidTX
036498603MedicaidTX
036498605MedicaidTX
036498602MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tpettijohn226400@direct.sw.org

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
I20100625000467 TX Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 6103819917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Texas Tech University Health Science Center School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

2020 W Hwy 114
Suite 200
Grapevine, TX 76051-8648
Phone (817) 416-7214

2020 W State Hwy 114 120
Baylor Family Med Ctr Grapevine
Grapevine, TX 76051-8648
Phone (817) 912-8300

4001 Worth St
Dallas, TX 75246-1608

4700 Alliance Blvd
Plano, TX 75093-5323

4716 Alliance Blvd
Plano, TX 75093-5325

5236 W University
4900 The Heart Group
McKinney, TX 75071-8185
Phone (469) 800-5350

5252 W University Dr
McKinney, TX 75071-7822
Phone (469) 764-6950

5408 Colleyville Blvd
Colleyville, TX 76034-5833
Phone (817) 498-9920

6000 W Spring Creek Pkwy
220 Baylor Scott and White Cardiovascular Con
Plano, TX 75024-3578
Phone (469) 800-4400

6601 Preston Rd
Plano, TX 75024-2502
Phone (469) 326-3400

8000 Warren Pkwy
104 Baylor Scott and White the Heart Group FR
Frisco, TX 75034-2225
Phone (469) 800-6500

821 N Coleman St
Suite 100
Prosper, TX 75078-2339
Phone (469) 800-5200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Oct 1, 2011 Accepting new patients
Healthtexas Provider Network CurrentSince Oct 1, 2011 Accepting new patients
Healthtexas Provider Network Internal Medicine Current Accepting new patients
Healthtexas Provider Network Internal Medicine Past Accepting new patients
Cardiovascular Consultants of North Texas, LLP Cardiovascular Disease Past Accepting new patients
Cardiovascular Consultants of North Texas, LLP Cardiovascular Disease Past Accepting new patients
Cardiovascular Consultants of North Texas, LLP Cardiovascular Disease Past Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (469) 800-8648

1600 W College St
Ste 510
Grapevine, TX 76051
Phone (817) 410-7982

1600 W College St
Ste 680
Grapevine, TX 76051
Phone (817) 481-9629

6000 W Spring Creek Pkwy
Ste 220
Plano, TX 75024
Phone (469) 800-4400

6300 W Parker Rd
Ste 125
Plano, TX 75093
Phone (469) 568-0400

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Interoperability endpoints

  • Direct secure messaging: tpettijohn226400@direct.sw.org

Ownership & related parties

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Baylor Scott & White the Heart Hospital - PlanoPlano, TX, CCN 670025 Hospital General Partnership Interest
Corporate Director		 Aug 4, 2004
Oct 27, 2024
Baylor Scott & White the Heart Hospital - DentonDenton, TX, CCN 450893 Hospital General Partnership Interest
Corporate Director		 Aug 4, 2004
Oct 27, 2024
Baylor Scott & White the Heart Hospital - DallasDallas, TX, CCN 450851 Hospital Corporate Director Feb 1, 2025
Baylor Scott & White the Heart Hospital RehabilitationDenton, TX, CCN 67T347 Hospital General Partnership Interest Nov 1, 2024
Baylor Scott & White the Heart Hospital - CorinthDenton, TX, CCN 670347 Hospital General Partnership Interest Nov 1, 2024

Owned or controlled facilities with NPI records 5

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

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1265468706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 W PARKER RD",
            "address_2": "MOB II 125",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750938100",
            "telephone_number": "469-800-4400",
            "fax_number": "469-800-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 W PARKER RD",
            "address_2": "MOB II 125",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750938100",
            "telephone_number": "469-800-4400",
            "fax_number": "469-800-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIJOHN",
        "first_name": "TRENT",
        "middle_name": "LEON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-25",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J4433",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "J4433",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "TX",
            "license": "J4433",
            "primary": true
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "TX",
            "license": "J4433",
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "TX",
            "license": "J4433",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8CX370",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036498604",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036498603",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036498605",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036498602",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tpettijohn226400@direct.sw.org",
            "affiliation": "N",
            "address_1": "6000 W Spring Creek Pkwy Ste 220",
            "city": "Plano",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750244128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.