Jaron Lee Pettis

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

01094579A Issued in IN

Practice address

1331 State St Ste 340
La Porte, IN 46350-3112

Phone

(219) 379-3166

NPI assigned

Mar 26, 2019

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

Medicare fee-for-service enrollment

Enrolled in IN

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

General Surgery

Education

University of South Carolina School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

La Porte Clinic Company LLCGroup PAC ID 0446558357, 66 clinicians

Rci (WRS) LLCGroup PAC ID 5092624510, shared by 17 NPIs, 325 clinicians

Porter Physician Services LLCGroup PAC ID 1850482407, 96 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwest Health-la Porte Hospital, La Porte, IN, CCN 150006
• Northwest Health - Porter Hospital, Valparaiso, IN, CCN 150035
• Northwest Health - Starke Hospital, Knox, IN, CCN 150102

Merit-based Incentive Payment System (MIPS)

Final score

90.68 of 100Reported as apm

Quality

76.2

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

90.68 of 100Reported as apm

Quality

76.2

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jaron.pettis.1@2340.direct.athenahealth.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.

• La Porte Clinic Company LLC

  • Internal Medicine Physician
  • Valparaiso, IN
  • NPI 1568829224

  Surgery

  Medicare reassignment Care Compare group NPD
• Porter Physician Services LLC

  • Family Medicine Physician
  • Valparaiso, IN
  • NPI 1508075680
  Medicare reassignment Care Compare group NPD
• La Porte Clinic Company LLC

  • Durable Medical Equipment & Medical Supplies
  • La Porte, IN
  • NPI 1275081788
  NPD

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

• Knox Hospital Company LLC

  • Rural Acute Care Hospital
  • Knox, IN
  • NPI 1679948319
  Care Compare affiliation
• La Porte Hospital Company LLC

  • General Acute Care Hospital
  • La Porte, IN
  • NPI 1750746285
  Care Compare affiliation
• Porter Hospital LLC

  • General Acute Care Hospital
  • Valparaiso, IN
  • NPI 1215151154
  Care Compare affiliation

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

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1366903015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 STATE ST STE 340",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463503112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 STATE ST STE 340",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463503112",
            "telephone_number": "219-379-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "JARON",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01094579A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawnna Peek, MSW
• Cygrid Kristie Perez, LCSW
• Silvio Richard Perez, MS SW
• Ashley Nicole Pesa, LMHC
• Erika Pettis
• Mark E Pettis, PTA
• Cynthia M Phelan, MD
• Hannah Phillips
• Dawn Marie Picard, AAS, MT
• James C Pickford, MD

• Surgery Physician in La Porte, IN
• Providers in La Porte, IN by specialty
• Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.