Katherine Marcela Pettyjohn, FNP-BC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

95009952 Issued in CA

Practice address

1409 Lecourbe CT
Modesto, CA 95356-8905

Phone

(209) 409-8239

Fax

(209) 409-8239

NPI assigned

Sep 9, 2018

Last updated

Sep 9, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Noble Group a Medical CorporationGroup PAC ID 4284528944, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Medical Center Hospital, Merced, CA, CCN 050444

Medicare enrollment (NPD)

Enrolled

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.

• The Noble Group a Medical Corporation

  dba Patients First Medical Center

  • General Practice Physician
  • Merced, CA
  • NPI 1336220557
  Medicare reassignment Care Compare group NPD
• Advance Nursing Practice Medical Group Inc

  • Family Nurse Practitioner
  • Modesto, CA
  • NPI 1699288993
  NPD (past)

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

• Dignity Health

  dba Mercy Medical Center Merced

  • General Acute Care Hospital
  • Merced, CA
  • NPI 1518018191
  Care Compare affiliation

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

{
    "created_epoch": "1536451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536451200000",
    "number": "1568945285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3880 COLMA AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953488719",
            "telephone_number": "209-617-4647",
            "fax_number": "209-409-8239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 LECOURBE CT",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568905",
            "telephone_number": "209-409-8239",
            "fax_number": "209-409-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTYJOHN",
        "first_name": "KATHERINE",
        "middle_name": "MARCELA",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-09",
        "last_updated": "2018-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "95009952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ekaterina Nikolaevna Petrova, MD
• Jonathan Matthew Pettegrew, D.O.
• Clair L. Pettinger, MD
• Monique Pettis, M.A., ED.S., PPS
• Sofia Ekaterina Pettygrove
• Rosa Peverini, MD
• Brad Edward Pezoldt, DDS MSD
• John Charles Pfeffer, M.D.
• Patrick D Pfizenmayer, MD
• Ruth Ethel Pflueger, NP, PA

• Primary Care Clinic/Center in Modesto, CA
• Providers in Modesto, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2018; 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.