Keith Pettibon, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

R1614 Issued in TX

Practice address

815 Pennsylvania Ave
Fort Worth, TX 76104

Phone

(817) 321-0404

NPI assigned

May 7, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, MS, LA3 enrollments

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 3

Specialty

Diagnostic Radiology

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Group practices

Ochsner Clinic LLCGroup PAC ID 8224933619, 2,845 clinicians

Methodist-CdiGroup PAC ID 3072836600, 43 clinicians

Radiology Associates of North Texas PAGroup PAC ID 7911897301, 340 clinicians

Crawford Andrews and Davis PTRGroup PAC ID 6507814084, 47 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baylor Scott and White All Saints Medical Center Hospital, Fort Worth, TX, CCN 450137
• Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135
• Medical City Weatherford Hospital, Weatherford, TX, CCN 450203
• Baylor Scott & White Medical Center Grapevine Hospital, Grapevine, TX, CCN 450563
• Texas Health Harris Methodist Hospital Southwest F Hospital, Fort Worth, TX, CCN 450779

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpettibon355606@ahs.direct-ci.com
• Direct secure messaging: kpettibon33438@cookchildrens.direct-ci.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.

• Crawford Andrews & Davis PTR

  • Diagnostic Radiology Physician
  • Beaumont, TX
  • NPI 1952325573
  Medicare reassignment Care Compare group NPD
• Methodist-Cdi

  • Diagnostic Radiology Physician
  • Plano, TX
  • NPI 1164829214
  Medicare reassignment Care Compare group NPD
• Radiology Associates of North Texas PA

  • Diagnostic Radiology Physician
  • Fort Worth, TX
  • NPI 1710970975
  Medicare reassignment Care Compare group NPD
• Ochsner Clinic LLC

  • General Practice Physician
  • New Orleans, LA
  • NPI 1538151428
  Medicare reassignment Care Compare group NPD
• Ochsner Mississippi, LLC

  • Internal Medicine Physician
  • Bay Saint Louis, MS
  • NPI 1538674239
  Medicare reassignment NPD
• Health Imaging Partners LLC

  • Physiological Laboratory
  • Dallas, TX
  • NPI 1144550369

  Diagnostic Radiology

  NPD
• Health Imaging Partners LLC

  • Physiological Laboratory
  • McKinney, TX
  • NPI 1215359401

  Diagnostic Radiology

  NPD
• Health Imaging Partners LLC

  • Physiological Laboratory
  • Allen, TX
  • NPI 1265762470

  Diagnostic Radiology

  NPD
• Health Imaging Partners LLC

  • Physiological Laboratory
  • Frisco, TX
  • NPI 1457681678

  Diagnostic Radiology

  NPD
• Health Imaging Partners LLC

  • Physiological Laboratory
  • Fort Worth, TX
  • NPI 1548590524

  Diagnostic Radiology

  NPD
• Health Imaging Partners LLC

  • Physiological Laboratory
  • Irving, TX
  • NPI 1659628659

  Diagnostic Radiology

  NPD
• Health Imaging Partners LLC

  • Physiological Laboratory
  • Cleburne, TX
  • NPI 1679994313

  Diagnostic Radiology

  NPD

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

• Baylor All Saints Medical Center

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1669472387
  Care Compare affiliation
• Baylor Regional Medical Center at Grapevine

  • General Acute Care Hospital
  • Grapevine, TX
  • NPI 1073511762
  Care Compare affiliation
• Texas Health Harris Methodist Hospital Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1336172105
  Care Compare affiliation
• Texas Health Harris Methodist Hospital Southwest Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1417980202
  Care Compare affiliation
• Weatherford Health Services, LLC

  • General Acute Care Hospital
  • Weatherford, TX
  • NPI 1417471467
  Care Compare affiliation

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

{
    "created_epoch": "1304726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1467744573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 W CANNON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043146",
            "telephone_number": "817-321-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-321-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIBON",
        "first_name": "KEITH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-07",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "TX",
            "license": "R1614",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "R1614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eduard Cristian Petreaca, PMHNP-BC
• Robert Petrie Jr., D.O.
• Glen O. Petta, DDS
• Joloni Pettes
• William Robert Pettey, MD
• Halie Alexis Petties
• Michael James Pettit, MD
• Britteny Petty
• Chelsea Petty, MS, LMFT-A
• Sarah Petty, MS

• Diagnostic Radiology Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.