Individual provider Active NPI

Jeffrey Lynn Pett, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Spokane Valley, WA
National Provider Identifier
1679540009
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD61113399 Issued in WA
Practice address
13103 E Mansfield Avenue
Spokane Valley, WA 99216-1642
Phone
(509) 892-2700
Fax
(509) 892-2740
NPI assigned
Mar 3, 2006
Last updated
Feb 17, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD61113399 WA Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 22578 AZ

Addresses

Primary practice location

13103 E Mansfield Avenue
Spokane Valley, WA 99216-1642

Mailing address

PO Box 3405
Spokane, WA 99220-3405
Phone (509) 892-2700

Other practice location 1

424 S 56th St Ste 120
Phoenix, AZ 85034-2177
Phone (602) 685-5211

Other practice location 2

1900 N Higley Rd
Gilbert, AZ 85234-1604
Phone (602) 685-5211

Other identifiers 2

IdentifierTypeStateIssuer
199308MedicaidAZ
2170571MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, ID, WA, OR4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20100923001423 AZ Practitioner - PathologyPractitioner - Other (Physician) 2860518180 Reassigns benefits to 1 organization
I20201202002070 ID Practitioner - Pathology 2860518180 Reassigns benefits to 1 organization
I20201202002230 WA Practitioner - Pathology 2860518180 Reassigns benefits to 1 organization
I20201210002957 OR Practitioner - Pathology 2860518180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Baylor College of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Incyte Pathology PLLCGroup PAC ID 9638067945, 43 clinicians

Practice addresses (Care Compare)

13103 E Mansfield Ave
Spokane Valley, WA 99216-1642
Phone (509) 892-2700

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.29 of 100Reported as group
Quality
68.58
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22578AZMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Incyte Pathology, LLC Anatomic Pathology & Clinical Pathology CurrentSince Dec 1, 2020 Accepting new patients
Clin-Path Pathology Anatomic Pathology & Clinical Pathology CurrentSince Nov 12, 2017 Accepting new patients
Sonoran Radiology LTD Past Accepting new patients

Locations

1900 N Higley Rd
Gilbert, AZ 85234
Phone (480) 543-2000

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

1800 E Van Buren St
Phoenix, AZ 85006
Phone (602) 251-8100

2000 W Bethany Home Rd
Phoenix, AZ 85015
Phone (480) 209-4000

424 S 56th St
Ste 110
Phoenix, AZ 85034
Phone (480) 478-8057

1255 W Washington St
Tempe, AZ 85288
Phone 602685521145166

1500 S Mill Ave
Tempe, AZ 85281
Phone (480) 784-5500

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

3001 St Anthony Way
Ste 107
Pendleton, OR 97801
Phone (541) 278-4755

221 Wellsian Way
Richland, WA 99352
Phone (503) 341-9352

13103 E Mansfield Ave
Spokane Valley, WA 99216

2811 S 102nd St
Ste 170
Tukwila, WA 98168
Phone (425) 646-0922

55 W Tietan St
Walla Walla, WA 99362
Phone (509) 525-3720

Interoperability endpoints

  • Direct secure messaging: jeffrey_pett_md@yourcarecommunity.org

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676592000000",
    "number": "1679540009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3405",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992203405",
            "telephone_number": "509-892-2700",
            "fax_number": "509-892-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13103 E MANSFIELD AVENUE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161642",
            "telephone_number": "509-892-2700",
            "fax_number": "509-892-2740"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "424 S 56th St Ste 120",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850342177",
            "country_code": "US",
            "telephone_number": "602-685-5211",
            "fax_number": "602-685-5325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1900 N Higley Rd",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852341604",
            "country_code": "US",
            "telephone_number": "602-685-5211",
            "fax_number": "602-685-5325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETT",
        "first_name": "JEFFREY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WA",
            "license": "MD61113399",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AZ",
            "license": "22578",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199308",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2170571",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

Verify at the official NPI Registry.