Gregory J Pettaway II, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

01078046A Issued in IN

Practice address

615 N Michigan St
South Bend, IN 46601-1033

Phone

(574) 647-1000

NPI assigned

Apr 30, 2014

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN, AL2 enrollments

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 2

Specialty

Emergency Medicine

Education

University of Alabama School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Island Medical Alabama LLCGroup PAC ID 3072682103, 24 clinicians

Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Huntsville Hospital Hospital, Huntsville, AL, CCN 010039
• Cullman Regional Medical Center Hospital, Cullman, AL, CCN 010035

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Baptist Health Medical Group Inc

  • Urgent Care Clinic/Center
  • Louisville, KY
  • NPI 1508269200

  IN

  Medicare reassignment Care Compare group NPD
• Island Medical Alabama LLC

  • Emergency Medicine Physician
  • Cullman, AL
  • NPI 1104097666
  Medicare reassignment Care Compare group NPD
• South Bend Emergency Physicians, Inc

  • Emergency Medicine Physician
  • South Bend, IN
  • NPI 1487132114
  Medicare reassignment NPD
• App of Alabama Ed PLLC

  • Emergency Medicine Physician
  • Russellville, AL
  • NPI 1659646040
  Medicare reassignment NPD
• Emergency Physicians Group

  • Emergency Medicine Physician
  • Huntsville, AL
  • NPI 1659366649
  Medicare reassignment NPD
• Gadsden HB Medical Services LLC

  • Emergency Medicine Physician
  • Gadsden, AL
  • NPI 1750061610
  Medicare reassignment NPD
• Ies Alabama PLLC

  • Emergency Medicine Physician
  • Foley, AL
  • NPI 1053027276
  Medicare reassignment NPD
• Immh Scottsboro LLC

  • Emergency Medicine Physician
  • Scottsboro, AL
  • NPI 1558762393
  Medicare reassignment NPD
• Baptist Health Medical Group Inc

  dba Dawson Springs Rural Health Clinic

  • Rural Health Clinic/Center
  • Dawson Springs, KY
  • NPI 1982178216
  NPD

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

• Cullman Regional Medical Center, Inc

  • General Acute Care Hospital
  • Cullman, AL
  • NPI 1114919339
  Care Compare affiliation
• The Health Care Authority of the City of Huntsville

  dba Huntsville Hospital

  • General Acute Care Hospital
  • Huntsville, AL
  • NPI 1447221056
  Care Compare affiliation

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

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1851701841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-1817",
            "fax_number": "574-647-3962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTAWAY",
        "first_name": "GREGORY",
        "middle_name": "J",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-30",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01078046A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300001115",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "941030008",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Faye Peterson-Pottinger, LCSW
• Charles E Peterson, MD
• Michelle Nicole Peterson, RDN
• Shotunus Denean Peterson, M.S.W
• Tim Peterson, MA
• Michael Pfeiffer, D.O.
• Jane P. Philips, RN, MS, OCN, CLT
• Ashley Jordyn Phillips
• Joann Lynn Phillips, M.S.W., L.S.W.
• Katelind Scarlett Phillips, CRNA

• Emergency Medicine Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Emergency Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.