Kenneth A Pettine, M.D.

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

29524 Issued in CO

Practice address

4795 Larimer Parkway
Johnstown, CO 80534

Phone

(970) 669-8881

Fax

(970) 669-4200

NPI assigned

Nov 10, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Orthopedic Pain Center

  dba Orrie G Clemens MD

  • Non-Pharmacy Dispensing Site
  • Fort Collins, CO
  • NPI 1336184548
  NPD (past)
• Pain Center of the Rockies

  dba Orthopedic Pain Center

  • Pain Medicine Physician
  • Loveland, CO
  • NPI 1356493548
  NPD (past)

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1720069198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4795 LARIMER PARKWAY",
            "city": "JOHNSTOWN",
            "state": "CO",
            "postal_code": "80534",
            "telephone_number": "970-669-8881",
            "fax_number": "970-669-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4795 LARIMER PARKWAY",
            "city": "JOHNSTOWN",
            "state": "CO",
            "postal_code": "80534",
            "telephone_number": "970-669-8881",
            "fax_number": "970-669-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTINE",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "CO",
            "license": "29524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01295245",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Olenic, PA-C
• Kristi Lynn Paetzel, PA-C
• Cherie Patterson
• Pca Ventures of Colorado LLC (Hays Market Pharmacy)
• Nicole Monet Peterson, PHARMD
• Jaime Lee Pingatore, PA-C
• Krista Lee Plate, FNP
• Poudre Valley Medical Group, LLC (UCHealth Medical Group)
• Samantha Poupore, MD
• Precision Family Eyecare PC

• Orthopaedic Surgery of the Spine Physician in Johnstown, CO
• Providers in Johnstown, CO by specialty
• Orthopaedic Surgery of the Spine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; 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.