Corwin D Petty, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E-2717 Issued in AR

Practice address

3201 S Market St Ste 105
Rogers, AR 72758-8168

Phone

(479) 254-1005

Fax

(479) 668-4003

NPI assigned

Jul 26, 2005

Sex

Male

Sole proprietor

No

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 AR

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

Specialty

Family Practice

Education

University of Arkansas College of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CGBDDD/Endpoint/CGBDDD
• FHIR API: https://api.platform.athenahealth.com/16989/brand/1/csg/1/fhir/r4

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.

• Corwin D. Petty, MD, PA

  • Family Medicine Physician
  • Rogers, AR
  • NPI 1881859593
  Medicare reassignment NPD Authorized official
• Rouse Family Medical Clinic PA

  • Family Medicine Physician
  • Springdale, AR
  • NPI 1275665523
  NPD (past)

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

• Mercy Hospital Rogers

  • General Acute Care Hospital
  • Rogers, AR
  • NPI 1316902414
  Care Compare affiliation

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522800000000",
    "number": "1295735959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 S MARKET ST STE 105",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588168",
            "telephone_number": "479-254-1005",
            "fax_number": "479-668-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 S MARKET ST STE 105",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588168",
            "telephone_number": "479-254-1005",
            "fax_number": "479-668-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "CORWIN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2018-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-2717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142693001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5C680",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5L696",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark John Perna, M.D.
• Perry Endodontics
• Candice Harper Perry, D.M.D.
• Charlotte Peters
• Sania Lynn Petties
• Giau Pham Bibiano, DPT
• Pharmacy Operations, Inc.
• Jennifer Phasey, LPN
• Stephen Todd Phelan, D.D.S.
• Emily Faith Philip

• Family Medicine Physician in Rogers, AR
• Providers in Rogers, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2018; 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.