Active NPI
Janet M Petitte, MS CCC/A
- Audiologist
- Summerville, SC
National Provider Identifier
1558519009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 4258
- Practice address
- 1801 Old Trolley Rd Ste 101
Summerville, SC 29485-8283 - Phone
- (843) 871-3235
- Fax
- (843) 871-3233
- NPI assigned
- Sep 8, 2008
- Last updated
- Jan 4, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | AT-005891 | PA | |
| Audiologist | 231H00000X | A-0177 | WV | |
| Audiologist | 231H00000X | 4258 | SC | Primary |
Addresses
Primary practice location
1801 Old Trolley Rd Ste 101
Summerville, SC 29485-8283
Mailing address
750 N Commons Dr Ste 200
Aurora, IL 60504-7940
Phone (630) 303-5380
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT-005891 | PA | MD | Audiologist |
| 4258 | SC | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connect Hearing Inc | Audiologist | Current | Accepting new patients |
| West Virginia University | Audiologist | Past | Accepting new patients |
Locations
750 N Commons Dr
Ste 200
Aurora, IL 60504
1801 Old Trolley Rd
Ste 101
Summerville, SC 29485
Phone (843) 871-3235
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704326400000",
"number": "1558519009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 N COMMONS DR STE 200",
"city": "AURORA",
"state": "IL",
"postal_code": "605047940",
"telephone_number": "630-303-5380",
"fax_number": "630-303-5385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 OLD TROLLEY RD STE 101",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294858283",
"telephone_number": "843-871-3235",
"fax_number": "843-871-3233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETITTE",
"first_name": "JANET",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "MS CCC/A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-08",
"last_updated": "2024-01-04",
"certification_date": "2024-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "PA",
"license": "AT-005891",
"primary": false
},
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "WV",
"license": "A-0177",
"primary": false
},
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "SC",
"license": "4258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summerville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.