William Harry Pettibon, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY6096 Issued in FL

Practice address

3800 S Tamiami TRL Unit 210
Sarasota, FL 34239-6909

Phone

(941) 366-1693

Fax

(941) 922-7574

NPI assigned

Oct 23, 2007

Sex

Male

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 FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

William H Pettibon PHD PAGroup PAC ID 7618025131, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• William H Pettibon PHD PA

  • Psychologist
  • Sarasota, FL
  • NPI 1336314707
  Medicare reassignment Care Compare group NPD Authorized official
• William H Pettibon PHD

  • Specialist
  • Sarasota, FL
  • NPI 1104839042
  NPD (past) Authorized official

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193097600000",
    "number": "1629267877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6521 KEYSTONE DR",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342317133",
            "telephone_number": "941-366-1693",
            "fax_number": "941-922-7574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 S TAMIAMI TRL UNIT 210",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342396909",
            "telephone_number": "941-366-1693",
            "fax_number": "941-922-7574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIBON",
        "first_name": "WILLIAM",
        "middle_name": "HARRY",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-23",
        "last_updated": "2007-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY6096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Pethtel, PSYD
• Alexander Nicholas Petreas, PA-C
• Elena Petrova, DDS
• Jennifer Lynn Petrucci, LMT
• Leah Corinne Petrucci, MA
• Erica Petty, MS CCC SLP
• Brianna Petys
• Krista Marie Peverini, CRNA
• Rachel Pfaus, PHARM.D.
• Amy Pfotenhauer

• Psychologist in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; 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.