Individual provider Active NPI

Angela Maris Pettenati, MD

  • Pediatrics Physician
  • Warren, OH
National Provider Identifier
1861489528
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35082903 Issued in OH
Practice address
5000 E Market St Ste 30
Warren, OH 44484-2259
Phone
(330) 856-9699
Fax
(330) 856-9935
NPI assigned
Sep 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35082903 OH Primary

Addresses

Primary practice location

5000 E Market St Ste 30
Warren, OH 44484-2259

Mailing address

1 Perkins SQ
Akron, OH 44308-1063
Phone (330) 856-9699

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address apettenati12760@direct.chmca.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20111205000195 OH Practitioner - Pediatric Medicine 5294900189 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35082903OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Akron Children'S Hospital Current Accepting new patients
Children'S Hospital Medical Center of Akron CurrentSince Nov 1, 2011 Accepting new patients
Children'S Hospital Medical Center of Akron Current Accepting new patients
Children'S Hospital Medical Center of Akron Pediatrics CurrentSince Nov 1, 2011 Accepting new patients

Locations

1 Perkins Sq
Akron, OH 44308
Phone (330) 543-8050

5000 E Market St
Ste 30
Warren, OH 44484
Phone (330) 856-9699

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1127865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1861489528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PERKINS SQ",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443081063",
            "telephone_number": "330-856-9699",
            "fax_number": "330-856-9935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 E MARKET ST STE 30",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444842259",
            "telephone_number": "330-856-9699",
            "fax_number": "330-856-9935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTENATI",
        "first_name": "ANGELA",
        "middle_name": "MARIS",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-28",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35082903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apettenati12760@direct.chmca.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5000 E Market St Ste 30",
            "city": "Warren",
            "state": "OH",
            "country_code": "US",
            "postal_code": "444842259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

Verify at the official NPI Registry.