Nicholas Roman Pettit, D.O., PH.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

02005159A Issued in IN

Practice address

1701 N Senate Blvd RM Ag012
Department of Emergency Medicine
Indianapolis, IN 46202-1239

Phone

(317) 962-5974

Fax

(317) 963-5394

NPI assigned

Jun 9, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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 1

Specialty

Emergency Medicine

Education

Ohio University, College of Osteopathic Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eskenazi Health Hospital, Indianapolis, IN, CCN 150024

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: npettit12989@direct.eskenazihealth.edu
• Direct secure messaging: npettit@direct.iuhealth.org

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.

• Iu Health Medical Group, LLC

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1326893777
  Medicare reassignment Care Compare group NPD
• Icem-Wishard LLC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1629304134
  Medicare reassignment NPD
• Indiana University Health Care Associates, Inc

  dba IU Health Physicians

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1902032832
  Medicare reassignment NPD
• University Medical Diagnostic Associates, Inc.

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1861441537
  NPD (past)

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

• The Health and Hospital Corporation of Marion County

  dba Eskenazi Health

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1568407310
  Care Compare affiliation
• The Health and Hospital Corporation of Marion County

  dba Eskenazi Health Midtown Narcotics Treatment Program

  • Methadone Clinic
  • Indianapolis, IN
  • NPI 1760922249

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1730538794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N SENATE BLVD RM AG012",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021239",
            "telephone_number": "317-962-5974",
            "fax_number": "317-963-5394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "NICHOLAS",
        "middle_name": "ROMAN",
        "name_prefix": "Dr.",
        "credential": "D.O., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-09",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "11018903A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02005159A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "npettit@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "1701 N Senate Blvd Rm Ag012",
            "address_2": "Department of Emergency Medicine",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Johnslynn Jalayne Pettiford
• Jordan E Pettiford
• Jasmin Pettigrew, PHARM D
• Shyanna Pettis
• Katie E Pettit, MD
• Rebecca Sue Pettit, PHARM.D.
• Jody S Petts, MD
• Benjamin D Petty, MD
• Cheryl Y Petty, RN,MSN,NP
• Heather Petty

• Emergency Medicine Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Emergency Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; 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.