NPIMap

Individual provider Active NPI

Kristen Aimee Pettrone, MD

  • Emergency Medicine Physician
  • Martinsburg, WV
National Provider Identifier
1760490916
Registry record updated Mar 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
22745 Issued in WV
Practice address
2500 Hospital Drive
Martinsburg, WV 25402-1150
Phone
(304) 264-1000
Fax
(304) 264-1374
NPI assigned
Aug 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 22745 WV Primary
Emergency Medicine Physician 207P00000X 2003-00680 NC

Addresses

Primary practice location

2500 Hospital Drive
Martinsburg, WV 25402-1150

Mailing address

PO Box 1150
Martinsburg, WV 25402-1150
Phone (304) 264-1000

Other identifiers 2

IdentifierTypeStateIssuer
N00685MedicaidSC
89135JUMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2003-00680NCMDEmergency Medicine Physician
22745WVMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Salutis Emergency Specialist, PLLC Emergency Medicine Past Accepting new patients
Iredell Memorial Hospital, Incorporated Past Accepting new patients
Internal Medicine Specialist, PA Past Accepting new patients
Piedmont Emergency Medical Associates, PA Emergency Medicine Past Accepting new patients
Shenandoah Memorial Hospital, Inc. Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269907200000",
    "number": "1760490916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1150",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254021150",
            "telephone_number": "304-264-1000",
            "fax_number": "304-264-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 HOSPITAL DRIVE",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254021150",
            "telephone_number": "304-264-1000",
            "fax_number": "304-264-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTRONE",
        "first_name": "KRISTEN",
        "middle_name": "AIMEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2010-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "22745",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2003-00680",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N00685",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89135JU",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2010; 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.