Beth Suzanne Pettis, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95016003 Issued in CA

Practice address

200 W Arbor Dr
San Diego, CA 92103-9000

Phone

(800) 926-8273

Fax

(888) 539-8781

NPI assigned

Jan 18, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sokyahealth Medical Group PCGroup PAC ID 8628463015, 180 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: beth.pettis.p1@direct.sokya.nextgenshare.com

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.

• Sokyahealth Medical Group PC

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1942970330
  Medicare reassignment Care Compare group NPD
• Headlight Health Medical Group PLLC

  • Psychiatry Physician
  • San Diego, CA
  • NPI 1649064486
  NPD

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

{
    "created_epoch": "1610928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1326638958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "BETH",
        "middle_name": "SUZANNE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-18",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95016003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Jane Pettek, NP
• Patricia Loy Petterson, PH.D.
• Faye Pettie
• Laura Pettijohn
• Alyssa Pettingill, CCLS
• Gabrielle Pettit
• James R. Pettit, M.D.
• Shannon Pettit
• Jeremy Hodson Pettus
• Asia Ruby Petty, B.A.

• Psychiatric/Mental Health Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; 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.