Amanda Jean Pettibone-Pond, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

01076608A Issued in IN

Practice address

1520 S Liberty Dr
Bloomington, IN 47403-5167

Phone

(812) 676-4500

Fax

(812) 676-4501

NPI assigned

Apr 13, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Urology

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Outer Banks Professional Services, LLCGroup PAC ID 3173652096, 163 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Outer Banks Hospital, Inc Hospital, Nags Head, NC, CCN 341324
• Chesapeake General Hospital Hospital, Chesapeake, VA, CCN 490120
• Vidant Chowan Hospital Hospital, Edenton, NC, CCN 341318
• Sentara Albemarle Medical Center Hospital, Elizabeth City, NC, CCN 340109
• Ecu Health Medical Center Hospital, Greenville, NC, CCN 340040

Merit-based Incentive Payment System (MIPS)

Final score

96.95 of 100Reported as apm

Quality

82.44

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Outer Banks Professional Services, LLC

  • Multi-Specialty Clinic/Center
  • Nags Head, NC
  • NPI 1891050357

  Urology

  Medicare reassignment Care Compare group NPD
• Vidant Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Greenville, NC
  • NPI 1477648731
  Medicare reassignment NPD
• Vidant Medical Group LLC

  • Ambulatory Surgical Clinic/Center
  • Kinston, NC
  • NPI 1376049619
  NPD

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

• Chesapeake Hospital Authority

  • General Acute Care Hospital
  • Virginia Beach, VA
  • NPI 1003265075
  Care Compare affiliation
• Chesapeake Hospital Authority

  • Pharmacy
  • Chesapeake, VA
  • NPI 1558466318

  Hospital

  Care Compare affiliation
• Chesapeake Hospital Authority

  • General Acute Care Hospital
  • Chesapeake, VA
  • NPI 1700896354
  Care Compare affiliation
• East Carolina Health - Chowan Inc

  • Critical Access Hospital
  • Edenton, NC
  • NPI 1477541183
  Care Compare affiliation
• Pitt County Memorial Hospital Inc

  • General Acute Care Hospital
  • Washington, NC
  • NPI 1780359687
  Care Compare affiliation
• Pitt County Memorial Hospital, Inc

  • General Acute Care Hospital
  • Greenville, NC
  • NPI 1043218944
  Care Compare affiliation
• Sentara Albemarle Regional Medical Center

  • General Acute Care Hospital
  • Elizabeth City, NC
  • NPI 1245211168
  Care Compare affiliation
• The Outer Banks Hospital Inc

  • Critical Access Hospital
  • Nags Head, NC
  • NPI 1053375253
  Care Compare affiliation

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

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467763200000",
    "number": "1790075596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 S LIBERTY DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035167",
            "telephone_number": "812-353-3087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 S LIBERTY DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035167",
            "telephone_number": "812-676-4500",
            "fax_number": "812-676-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIBONE-POND",
        "first_name": "AMANDA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-13",
        "last_updated": "2016-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "01076608A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Peterson, OT
• Erica Christine Peterson, RN
• Courtney Petrie
• Misty Susanne Petro, PTA,ATC,CSCS
• Kaitlyn Petrow
• Colton Phelps
• Deborah Phelps, MT-BC
• Jennifer Phelps, NP-C
• Thomas D Phelps, LMHC
• Philip a. Crooke, M.D., P.C.

• Urology Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Urology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; 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.