NPIMap

Individual provider Active NPI

India Pettus, PA-C

  • Physician Assistant
  • Chevy Chase, MD
National Provider Identifier
1306270533
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0005125 Issued in MD
Practice address
5530 Wisconsin Ave
Suite 1660
Chevy Chase, MD 20815-4404
Phone
(301) 657-9876
NPI assigned
Aug 23, 2013
Last updated
Jan 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0005125 MD Primary
Surgical Physician Assistant 363AS0400X C0005125 MD

Addresses

Primary practice location

5530 Wisconsin Ave
Suite 1660
Chevy Chase, MD 20815-4404

Mailing address

7250 Parkway Dr Ste 500
Hanover, MD 21076-1343
Phone (443) 949-0814

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD, VA, MN4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20140409001783 DC Practitioner - Physician Assistant 5496987281 Reassigns benefits to 7 organizations
I20150608002474 MD Practitioner - Physician Assistant 5496987281 Reassigns benefits to 5 organizations
I20230313001304 VA Practitioner - Physician Assistant 5496987281 Reassigns benefits to 3 organizations
I20251218003470 MN Practitioner - Physician Assistant 5496987281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

1015 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-6360

2900 Mercy LN
Cheverly, MD 20785-1157
Phone (301) 618-2273

901 Harry S Truman Dr N
Upper Marlboro, MD 20774-5477
Phone (240) 677-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
15590MNMDClinical Social Worker
C0005125MDMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centers for Advanced Orthopaedics, LLC CurrentSince Mar 1, 2014 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Nov 1, 2025 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Feb 1, 2023 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Nov 1, 2025 Accepting new patients
Northwest Hospital Center, Inc. CurrentSince May 27, 2020 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Feb 1, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Sep 10, 2022 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Mar 1, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Feb 1, 2023 Accepting new patients
Northwest Hospital Center, Inc Physician Assistant CurrentSince May 27, 2020 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Feb 1, 2023 Accepting new patients
Centers for Advanced Orthopaedics, LLC CurrentSince Jan 20, 2026 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Feb 1, 2023 Accepting new patients
Centers for Advanced Orthopaedics, LLC CurrentSince Jan 7, 2026 Accepting new patients
Centers for Advanced Orthopaedics, LLC CurrentSince Mar 1, 2014 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Mar 1, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Sep 10, 2022 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Feb 1, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Sep 10, 2022 Accepting new patients
Orthopaedic Associates of Central Maryland, PA Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

5530 Wisconsin Ave
Ste 1660
Chevy Chase, MD 20815
Phone (301) 657-9876

10710 Charter Dr
Ste 300
Columbia, MD 21044
Phone 4106441880450

7070 Samuel Morse Dr
Columbia, MD 21046
Phone (410) 309-4600

7190 Crestwood Blvd
Frederick, MD 21703
Phone (240) 529-1700

86 Thomas Johnson Ct
Frederick, MD 21702
Phone (301) 607-0444

1701 Twin Springs Rd
Halethorpe, MD 21227
Phone (410) 737-5000

10810 Connecticut Ave
Kensington, MD 20895
Phone (301) 929-7100

1221 Mercantile Ln
Fl 3
Largo, MD 20774
Phone (301) 618-5500

655 Watkins Mill Rd
Montgomery Village, MD 20879
Phone (301) 929-7100

3414 Olandwood Ct
Olney, MD 20832
Phone (301) 774-0500

5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727

2101 E Jefferson St
#4E
Rockville, MD 20852

2101 E Jefferson St
Ste 4EAST
Rockville, MD 20852

2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853

6701 N Charles St
Towson, MD 21204
Phone (443) 849-2000

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

8525 Rolling Rd
Ste 300
Manassas, VA 20110
Phone (703) 361-0465

1510 N 28th St
Ste 110
Richmond, VA 23223
Phone (804) 545-2304

8008 Westpark Dr
Tysons Corner, VA 22102
Phone (703) 287-6400

14139 Potomac Mills Rd
Woodbridge, VA 22192
Phone (703) 257-3000

14605 Potomac Branch Dr
Ste 300
Woodbridge, VA 22191
Phone (703) 490-1112

Interoperability endpoints

  • Direct secure messaging: 60ipettus@cfaortho.emadirect.md
  • Direct secure messaging: ipettus1018700@direct.hopkinsmedicine.org
  • Direct secure messaging: ipettus440689@direct.aspirus.org
  • Direct secure messaging: ipettus801780@direct.umm.edu

Organizations & group practices 29

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.

View all 29

Hospital & facility affiliations 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1377216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1306270533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7250 PARKWAY DR STE 500",
            "city": "HANOVER",
            "state": "MD",
            "postal_code": "210761343",
            "telephone_number": "443-949-0814",
            "fax_number": "443-949-0825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5530 WISCONSIN AVE",
            "address_2": "SUITE 1660",
            "city": "CHEVY CHASE",
            "state": "MD",
            "postal_code": "208154404",
            "telephone_number": "301-657-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTUS",
        "first_name": "INDIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-23",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0005125",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C0005125",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5530 Wisconsin Ave",
            "address_2": "Suite 1660",
            "city": "Chevy Chase",
            "state": "MD",
            "country_code": "US",
            "postal_code": "208154404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chevy Chase, MD

Sources for this page

Verify at the official NPI Registry.