Ericka M. Russell Petty, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

047258 Issued in GA

Practice address

3710 Waters Ave
Savannah, GA 31404-6209

Phone

(912) 777-5490

Fax

(912) 777-5491

NPI assigned

Oct 28, 2005

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

Other identifiers 4

Other names 1

• Dr. Ericka M. Russell-Petty Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Peds Health

  • Health Service Clinic/Center
  • Savannah, GA
  • NPI 1215483128
  NPD (past) Authorized official
• Candler Hospital Incorporated

  • General Acute Care Hospital
  • Savannah, GA
  • NPI 1275527889
  NPD (past)

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376352000000",
    "number": "1659362705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5710 OGEECHEE RD",
            "address_2": "STE 200 BOX 283",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314059515",
            "telephone_number": "912-777-5490",
            "fax_number": "912-777-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 WATERS AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314046209",
            "telephone_number": "912-777-5490",
            "fax_number": "912-777-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL PETTY",
        "first_name": "ERICKA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-28",
        "last_updated": "2013-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "047258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000880448D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000880448H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000880448C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000880448E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERICKA",
            "last_name": "RUSSELL-PETTY",
            "middle_name": "M.",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Anne Lorraine Rumpel, LPC, NCC, CPCS
• Christin Jamie Runkel, DPM
• Rural Urgent Care LLC
• George Rush, MLS
• Sarah Rush, PA
• Ashleigh Strickland Russell, F.N.P.
• Janay C Russell
• Kahala Russell, LPC, CCAADC
• Megan A Russell, M.D.
• Phyllis Russell, LMT

• Pediatrics Physician in Savannah, GA
• Providers in Savannah, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.