Emily Brooke Pettis, CRNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

AG0114029 Issued in AL

Practice address

1118 Ross Clark Cir Ste 100
Dothan, AL 36301-3023

Phone

(334) 794-1148

NPI assigned

Sep 29, 2014

Sex

Female

Sole proprietor

Yes

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 AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dothan Medical Associates, P.C.Group PAC ID 7416848247, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: ebpettis@dmapc.gwaydirect.com

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.

• Dothan Medical Associates, P.C.

  • Internal Medicine Physician
  • Dothan, AL
  • NPI 1972693778
  Medicare reassignment Care Compare group

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

• Houston County Healthcare Authority

  • General Acute Care Hospital
  • Dothan, AL
  • NPI 1164403861
  Care Compare affiliation

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

{
    "created_epoch": "1411948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412035200000",
    "number": "1811390396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 ROSS CLARK CIR STE 100",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013023",
            "telephone_number": "334-794-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 ROSS CLARK CIR STE 100",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013023",
            "telephone_number": "334-794-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "EMILY",
        "middle_name": "BROOKE",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-29",
        "last_updated": "2014-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AL",
            "license": "AG0114029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly Peters, RBT
• Daniel R Peters, PT
• Hannah Luke Peters, LPTA
• Deandrea Dickens Peterson, LPC
• Sharon Ann Petrie, LPC
• Natalie Corinne Pettis, LMT
• Pfeifer Psychiatry LLC
• Jonathan C Pfeifer, MD
• Ralph Burton Pfeiffer III, M.D.
• Brian Pfister, DDS

• Adult Health Nurse Practitioner in Dothan, AL
• Providers in Dothan, AL by specialty
• Adult Health Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2014; 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.