Caitlen M Petschke, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2275 Issued in TN

Practice address

101 Med Tech Pkwy
Ste. 405
Johnson City, TN 37604-4007

Phone

(423) 929-2452

Fax

(423) 929-2531

NPI assigned

Mar 9, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Blue Ridge Medical Management Corporation

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  Medicare reassignment
• SHC Medical Partners of Tennessee, LLC

  • Nurse Practitioner
  • Mountain City, TN
  • NPI 1609051895
  Medicare reassignment
• Blue Ridge Medical Management Corporation

  • Family Medicine Physician
  • Kingsport, TN
  • NPI 1730401209
  NPD
• Blue Ridge Medical Management Corporation

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD
• Blue Ridge Medical Management Corporation

  • Cardiovascular Disease Physician
  • Johnson City, TN
  • NPI 1740227131
  NPD (past)

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

{
    "created_epoch": "1299628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376524800000",
    "number": "1558669986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MED TECH PKWY",
            "address_2": "STE. 405",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044007",
            "telephone_number": "423-929-2452",
            "fax_number": "423-929-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MED TECH PKWY",
            "address_2": "STE. 405",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044007",
            "telephone_number": "423-929-2452",
            "fax_number": "423-929-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETSCHKE",
        "first_name": "CAITLEN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-09",
        "last_updated": "2013-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "PA200351",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "2275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2158848",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Ashley Peterson Taylor, PMHNP
• Janette R. Peterson, NP
• Steve Leroy Peterson, M.D.
• Tracey E Peterson, BSW
• Erica Petree, LCSW
• Elizabeth A Pettey, NP
• Thelia Jean Pettigrew, LPN
• Hannah Jo Pettit, PA-C
• Joshua Robert Pettit, PA
• Justin Pettit, PA

• Medical Physician Assistant in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2013; 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.