Tinesha Shanta Pettiway

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

1129705 Issued in TX

Practice address

205 E Medical Center Blvd # 100
Webster, TX 77598-4376

Phone

(346) 800-6001

NPI assigned

Jul 25, 2023

Last updated

Oct 16, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Minivasive Pain Specialists,PLLCGroup PAC ID 7113278896, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19285/brand/4/csg/1/fhir/r4

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.

• Minivasive Pain Specialists,PLLC

  dba Minivasive Pain & Orthopedics

  • Interventional Pain Medicine Physician
  • Spring, TX
  • NPI 1477099851
  Medicare reassignment Care Compare group NPD
• Houston Kidney Specialists Center PLLC

  • Nephrology Physician
  • Houston, TX
  • NPI 1396217162
  NPD (past)

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

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1881375780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 STAFFORD RD APT 1321",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774773576",
            "telephone_number": "205-401-7386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E MEDICAL CENTER BLVD # 100",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775984376",
            "telephone_number": "346-800-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIWAY",
        "first_name": "TINESHA",
        "middle_name": "SHANTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-25",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "1129705",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1129705",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "1129705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yvette Monique Perez
• Nicola Perry
• Michael Petitt, MD
• Bart Edward Petrini, MD
• Lorena Rebeca Pettiette
• Adrianna Symone Pfeifer, DOULA
• PG Daley & CR Boone PTR Clear Lake Physical Therapy (Clear Lake Physical Therapy)
• Diana Pham, N.P.
• Hoang Pham, MD
• Sarah Pham

• Gerontology Nurse Practitioner in Webster, TX
• Providers in Webster, TX by specialty
• Gerontology Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; 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.