Wendell E Petty, M.D.

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

MD-2580 Issued in ID

Practice address

3422 S 15TH E
Idaho Falls, ID 83404-8262

Phone

(208) 529-9292

Fax

(208) 525-6013

NPI assigned

Mar 30, 2006

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 4

Other names 1

• Dr. Gene Petty Other name

Medicare fee-for-service enrollment

Enrolled in ID

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

Allergy/Immunology

Education

Other, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Idaho Allergy and Asthma Clinic PAGroup PAC ID 2860440732, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.7 of 100Reported as group

Quality

88.89

Improvement activities

40

Cost

63.83

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Idaho Allergy & Asthma Clinic PA

  • Allergy & Immunology Physician
  • Idaho Falls, ID
  • NPI 1003949298
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1457312308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3422 S 15TH E",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048262",
            "telephone_number": "208-529-9292",
            "fax_number": "208-525-6013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3422 S 15TH E",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048262",
            "telephone_number": "208-529-9292",
            "fax_number": "208-525-6013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "WENDELL",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "ID",
            "license": "MD-2580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "76891",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010004631",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002516900",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "030000684",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GENE",
            "last_name": "PETTY",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Eric Vernon Pettingill, LCPC
• Tamara K. Pettingill, LCSW
• Robert John Pettit, MD
• David Aaron Petty, D.O.
• Kayla Suann Petty
• Douglas Frank Pfister, ASLD
• Pharmacy Care Consultants
• Emily Phenix
• Molly Susan Phillipp, C.R.N.P.
• James William Phillippi, D.O.

• Allergy & Immunology Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Allergy & Immunology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; 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.