Individual provider Active NPI

Daniel Pettit, D.O.

  • Family Medicine Physician
  • Ann Arbor, MI
National Provider Identifier
1285868588
Registry record updated Aug 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101024423 Issued in MI
Practice address
4350 Jackson Rd Ste 200
Ann Arbor, MI 48103-1889
Phone
(734) 761-2581
Fax
(734) 761-9540
NPI assigned
May 14, 2009
Last updated
Aug 27, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2019

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 02003818A IN
Family Medicine Physician 207Q00000X 5101024423 MI Primary

Addresses

Primary practice location

4350 Jackson Rd Ste 200
Ann Arbor, MI 48103-1889

Mailing address

24 Frank Lloyd Wright Dr Lbby J2000
Ann Arbor, MI 48105-9484
Phone (734) 747-6766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190613002865 MI Practitioner - Family Practice 9931378270 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

4350 Jackson Rd
Suite 200
Ann Arbor, MI 48103-1889
Phone (734) 761-2581

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Family Medicine CurrentSince Jul 1, 2019 Accepting new patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Service Corporation CurrentSince Jul 1, 2019 Accepting new patients
Iha Health Services Corporation Family Medicine Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

3200 W Liberty Rd
Ste C
Ann Arbor, MI 48103
Phone (734) 761-2581

4350 Jackson Rd
Ste 200
Ann Arbor, MI 48103
Phone (734) 761-2581

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

Organizations & group practices 4

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 2

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": "1242259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1285868588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR LBBY J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 JACKSON RD STE 200",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481031889",
            "telephone_number": "734-761-2581",
            "fax_number": "734-761-9540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "DANIEL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-14",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02003818A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101024423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.