Timothy Pettingell, M.D.

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

20806 Issued in OK

Practice address

4735 E 91St St
Suite 100
Tulsa, OK 74137-2807

Phone

(918) 252-7952

Fax

(918) 252-9218

NPI assigned

May 23, 2005

Reactivated

Mar 28, 2006

Last updated

May 29, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

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

Physical Medicine and Rehabilitation

Education

Louisiana State University School of Medicine in Shreveport, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: timothy.pettingell@direct.stjohnhealthsystem.com

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.

• Oklahoma Physical Medicine and Rehabilitation, PC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Broken Arrow, OK
  • NPI 1427279561
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338249600000",
    "number": "1376546531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10026 S MINGO RD STE A",
            "address_2": "PMB 234",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335717",
            "telephone_number": "918-252-7952",
            "fax_number": "918-252-9218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4735 E 91ST ST",
            "address_2": "SUITE 100",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741372807",
            "telephone_number": "918-252-7952",
            "fax_number": "918-252-9218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTINGELL",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2012-05-29",
        "deactivation_date": "2006-03-15",
        "reactivation_date": "2006-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "OK",
            "license": "20806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100251620A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seana Lynn Petri, MA, LPC, CRC
• Carmen Pettie
• Bruce Ben Pettigrove, M.D.
• Nicholas J Pettinelli, DO
• Haley Pettingell
• William J Pettit, D.O.
• Donna Lynn Petty, RN
• Jo Leslie Petty, MS ARNP
• Jonathan Paul Petty, COTA/L
• Mechelle Petty

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2012; 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.