Sue Ellen Petty, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

34383 Issued in KY

Practice address

320 Micbeth Dr
Princeton, KY 42445-6332

Phone

(270) 365-0320

Fax

(270) 365-4150

NPI assigned

Nov 7, 2006

Last updated

Nov 29, 2017By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pinelake Physician Practice, LLC

  • Rural Health Clinic/Center
  • Mayfield, KY
  • NPI 1295960532
  Medicare reassignment NPD
• Pinelake Physician Practice, LLC

  • Rural Health Clinic/Center
  • Mayfield, KY
  • NPI 1841900347
  NPD
• Pinelake Physician Practice, LLC

  dba Jackson Purchase Podiatry

  • Internal Medicine Physician
  • Mayfield, KY
  • NPI 1861563439

  Surgery

  NPD
• Western Baptist Medical Ventures Inc

  dba Baptist Health Cancer Care & Blood Disorders

  • Hematology & Oncology Physician
  • Paducah, KY
  • NPI 1750729133
  NPD (past)
• Western Baptist Medical Ventures, Inc.

  dba Paducah Neurosurgical Center

  • Neurological Surgery Physician
  • Paducah, KY
  • NPI 1316017080
  NPD (past)

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511913600000",
    "number": "1477622181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 410",
            "city": "PRINCETON",
            "state": "KY",
            "postal_code": "42445",
            "telephone_number": "270-365-0320",
            "fax_number": "270-365-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 MICBETH DR",
            "city": "PRINCETON",
            "state": "KY",
            "postal_code": "424456332",
            "telephone_number": "270-365-0320",
            "fax_number": "270-365-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "SUE",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2017-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "34383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64343833",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pennyrile District Health Department (Caldwell County Middle School)
• Pennyrile District Health Department (Caldwell Co Tiger Clinic)
• Pennyrile District Lhealth Department (Caldwell Co Tiger Pride Clinic)
• Pennyroyal Healthcare Services, Inc
• Perry Family Medical PLLC
• Shanna Phillips, P.T.
• Rebecca Sue Porter
• Primaricare, PLLC
• Princeton Family Care, PLLC
• Princeton Health & Rehab Center, Inc.

• Surgery Physician in Princeton, KY
• Providers in Princeton, KY by specialty
• Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.