NPIMap

Individual provider Active NPI

Jared B Petty, DO

  • Internal Medicine Physician
  • Winnsboro, TX
National Provider Identifier
1720280753
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M7519 Issued in TX
Practice address
209 E Broadway St
Winnsboro, TX 75494-2604
Phone
(903) 342-3355
NPI assigned
Jun 1, 2007
Last updated
Mar 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X M7519 TX Primary

Addresses

Primary practice location

209 E Broadway St
Winnsboro, TX 75494-2604

Mailing address

209 E Broadway St
Winnsboro, TX 75494-2604
Phone (903) 342-3355

Other identifiers 6

IdentifierTypeStateIssuer
7527715699005OtherTXTRICARE
8DB900OtherTXBCBS
206328102MedicaidTX
8V3853OtherTXBCBS
75-2616977-042OtherTXTRICARE
TIN PLUS 083OtherTXTRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090814000519 TX Practitioner - Internal Medicine 8022162759 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Arizona College of Osteopathic Medicine Mid Western University, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Winnsboro Health Services PLLCGroup PAC ID 2668784083, 3 clinicians

Practice addresses (Care Compare)

209 E Broadway St
Winnsboro, TX 75494-2604
Phone (903) 342-3355

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Winnsboro Health Services PLLC Internal Medicine CurrentSince Apr 6, 2015 Accepting new patients
Quitman Hospital LLC Internal Medicine CurrentSince Mar 1, 2018 Accepting new patients
Etmc Physician Group Inc. CurrentSince Mar 3, 2018 Accepting new patients
Christus Trinity Clinic Texas Internal Medicine CurrentSince May 30, 2011 Accepting new patients
Quitman Hospital LLC CurrentSince Mar 1, 2018 Accepting new patients
Etmc Physician Group Inc. CurrentSince Mar 3, 2018 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Mar 11, 2017 Accepting new patients
Quitman Hospital LLC Current Accepting new patients
Christus Trinity Clinic Texas CurrentSince May 30, 2011 Accepting new patients
Cogent Healthcare of Texas, PA Internal Medicine CurrentSince Feb 1, 2019 Accepting new patients
Stratford Hospital District Past Accepting new patients
Mother Frances Hospital Winnsboro Past Accepting new patients
Nocona Hospital District Past Accepting new patients

Locations

340 Seven Springs Way
Ste 100
Brentwood, TN 37027
Phone (615) 296-3000

1007 S William St
Atlanta, TX 75551
Phone (903) 614-2000

3201 W State Highway 22
Corsicana, TX 75110
Phone (903) 654-6800

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

18951 N Memorial Dr
Humble, TX 77338
Phone (281) 319-8409

2114 E Rusk St
Jacksonville, TX 75766
Phone (903) 284-6105

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

117 N Winnsboro St
Quitman, TX 75783
Phone (903) 763-4505

3150 Horizon Rd
Rockwall, TX 75032
Phone (469) 697-1000

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

209 E Broadway St
Winnsboro, TX 75494
Phone (903) 342-3355

719 W Coke Rd
Ste 4
Winnsboro, TX 75494
Phone (903) 342-3760

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11327/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jared.petty.1@11327.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sunny Springs Nursing & RehabSulphur Springs, TX, CCN 675664 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 25, 2025
May 25, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 11

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": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1720280753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 E BROADWAY ST",
            "city": "WINNSBORO",
            "state": "TX",
            "postal_code": "754942604",
            "telephone_number": "903-342-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 E BROADWAY ST",
            "city": "WINNSBORO",
            "state": "TX",
            "postal_code": "754942604",
            "telephone_number": "903-342-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "JARED",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "M7519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "7527715699005",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8DB900",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206328102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8V3853",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-042",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "TIN PLUS 083",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winnsboro, TX

Sources for this page

Verify at the official NPI Registry.