NPIMap

Individual provider Active NPI

Jason R Pettus, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Lebanon, NH
National Provider Identifier
1841464120
Registry record updated Sep 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
16131 Issued in NH
Practice address
One Medical Center Dr
Dartmouth-Hitchcock Medical Center, Dept. of Pathology
Lebanon, NH 03756-1000
Phone
(603) 650-5000
NPI assigned
Apr 17, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 250580 MA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 16131 NH Primary

Addresses

Primary practice location

One Medical Center Dr
Dartmouth-Hitchcock Medical Center, Dept. of Pathology
Lebanon, NH 03756-1000

Mailing address

One Medical Center Dr
Dartmouth-Hitchcock Medical Center, Dept. of Pathology
Lebanon, NH 03756-1000
Phone (603) 650-5000

Other identifiers 2

IdentifierTypeStateIssuer
1021925MedicaidVT
3086997MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130814000381 NH Practitioner - Pathology 0547425050 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Missouri, Columbia School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dartmouth-Hitchcock ClinicGroup PAC ID 4183537509, 1,445 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Lebanon, NH 03756-1000
Phone (603) 650-5000

PO Box
Suite 810
Hanover, NH 03755-0810

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.66 of 100Reported as apm
Quality
53.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16131NHMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Hitchcock Memorial Hospital CurrentSince Jan 13, 2025 Accepting new patients
Dartmouth-Hitchcock Clinic Anatomic Pathology & Clinical Pathology CurrentSince Jul 1, 2013 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Jan 13, 2025 Accepting new patients

Locations

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

Organizations & group practices 3

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378684800000",
    "number": "1841464120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE MEDICAL CENTER DR",
            "address_2": "DARTMOUTH-HITCHCOCK MEDICAL CENTER, DEPT. OF PATHOLOGY",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE MEDICAL CENTER DR",
            "address_2": "DARTMOUTH-HITCHCOCK MEDICAL CENTER, DEPT. OF PATHOLOGY",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTUS",
        "first_name": "JASON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-17",
        "last_updated": "2013-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MA",
            "license": "250580",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NH",
            "license": "16131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021925",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3086997",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.