Corwin D. Petty, MD, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CORWIN D. PETTY, MD, PA

Practice address

3201 S Market St Ste 105
Rogers, AR 72758-8168

Phone

(479) 254-1005

Fax

(479) 668-4003

NPI assigned

Jul 22, 2008

Organization subpart

Yes

Parent organization

PETTY MEDICAL CLINICAs reported in NPPES

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

Authorized official

Name

Dr. Corwin D Petty, MDNPI 1295735959

Title

Owner / Physician

Phone

(479) 254-1005

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Part of

Petty Medical Clinic LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Petty Medical Clinic, LLC

  • Primary Care Clinic/Center
  • Lowell, AR
  • NPI 1255746772
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Corwin D Petty, MD

  • Family Medicine Physician
  • Rogers, AR
  • NPI 1295735959
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522800000000",
    "number": "1881859593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 S MARKET ST STE 105",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588168",
            "telephone_number": "479-254-1005",
            "fax_number": "479-668-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 S MARKET ST STE 105",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588168",
            "telephone_number": "479-254-1005",
            "fax_number": "479-668-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORWIN D. PETTY, MD, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PETTY MEDICAL CLINIC",
        "enumeration_date": "2008-07-22",
        "last_updated": "2018-04-04",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "CORWIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER / PHYSICIAN",
        "authorized_official_telephone_number": "479-254-1005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5C680",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149427002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalie Cordoza, MS, RD, LD
• Keri Lynn Corn, LAC
• Cornerstone Pharmacy at Rogers, LLC (Heartland Pharmacy Rogers)
• Nicholas Cornett, PHD, LPC, LMFT
• Corporate Chiropractic Health
• Leah Marie Cossey, APRN
• Mario E Costaldi, M.D.
• Keeley Cotter, OTD, OTR/L
• Andrew John Couture, MD
• Robin A. Cox, DO

• Family Medicine Physician in Rogers, AR
• Providers in Rogers, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.