Marissa A Pettit, CNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

CNP-02278 Issued in NM

Practice address

2211 Lomas Blvd NE
Albuquerque, NM 87106-2719

Phone

(505) 272-6646

Fax

(505) 272-6665

NPI assigned

Nov 7, 2013

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 NM

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

Women'S Cancer and Surgical Care, PCGroup PAC ID 9638220833, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

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.

• Women'S Cancer and Surgical Care PC

  • Gynecologic Oncology Physician
  • Albuquerque, NM
  • NPI 1871728840
  Medicare reassignment Care Compare group NPD
• Albuquerque Dermatology Associates, PA

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1821045329
  NPD (past)

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483574400000",
    "number": "1831528090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 LOMAS BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871062719",
            "telephone_number": "505-272-6646",
            "fax_number": "505-272-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 LOMAS BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871062719",
            "telephone_number": "505-272-6646",
            "fax_number": "505-272-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "MARISSA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-07",
        "last_updated": "2017-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NM",
            "license": "CNP-02278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stuart Pett, MD
• Cathy Anne Petti, MD
• Kali Suzanne Nan Petties, T-CTL0220451
• Angela Pettiford
• Raine Pettigrew
• Matthew Pettit
• Margaret Ann Pettus, SLP
• Brenda Kay Petty, DOM
• Sara Peugh, MSW LISW
• Daniel Ricardo Peverini, MD

• Acute Care Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Acute Care Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2017; 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.