Ryan Pettit, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

O-1017 Issued in ID

Practice address

4424 E Flamingo
Ste 200
Nampa, ID 83687

Phone

(208) 302-1400

Fax

(208) 302-1455

NPI assigned

Jun 13, 2013

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 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

Obstetrics/Gynecology

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifestages OB-GYN PLLCGroup PAC ID 0648226266, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rpettit1564347@direct.trinity-health.org

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.

• Lifestages OB-GYN PLLC

  • Obstetrics & Gynecology Physician
  • Nampa, ID
  • NPI 1871618892
  Medicare reassignment Care Compare group NPD
• Saint Alphonsus Regional Medical Center Inc

  • Psychologist
  • Boise, ID
  • NPI 1649357716
  Medicare reassignment NPD
• Saint Alphonsus Regional Medical Center Inc

  • Psychiatric Hospital Unit
  • Boise, ID
  • NPI 1770687857
  NPD
• Saint Alphonsus Regional Medical Center Inc

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1992736649
  NPD
• Saint Alphonsus Specialty Services Inc

  • Trauma Surgery Physician
  • Boise, ID
  • NPI 1093040479

  Obstetrics & Gynecology

  NPD (past)

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

• Saint Alphonsus Medical Center Nampa, Inc.

  • General Acute Care Hospital
  • Nampa, ID
  • NPI 1659371870
  Care Compare affiliation

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

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1487092292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-302-1400",
            "fax_number": "208-302-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4424 E FLAMINGO",
            "address_2": "STE 200",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "83687",
            "telephone_number": "208-302-1400",
            "fax_number": "208-302-1455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "RYAN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-13",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "2013017878",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "O-1017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hawley Peterman
• Alyssa Peters, LCPC
• Kaitlin Peters, RN
• Gail Ingra Peterson, M.S, LCPC
• Kendra Tamar Pettit, LPC
• Ethan Tan Phan, PHARMD
• Rosemary Phelps
• Kathryn Lee Philbrook
• Phillips Counseling Services, PLLC
• Natalie Susan Phillips, LMSW

• Obstetrics & Gynecology Physician in Nampa, ID
• Providers in Nampa, ID by specialty
• Obstetrics & Gynecology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.