Matthew Sean Petitt, DO

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

M2750 Issued in TX

Practice address

4419 Crenshaw Rd
Pasadena, TX 77504-3628

Phone

(281) 991-5944

NPI assigned

Jun 14, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

DermatologyAlso: Pathology

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Dermatology, P.a.Group PAC ID 5193715571, 12 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Southeast Dermatology, P.a.

  • Dermatology Physician
  • Pasadena, TX
  • NPI 1811932205
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1912101593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4419 CRENSHAW RD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775043628",
            "telephone_number": "281-991-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4419 CRENSHAW RD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775043628",
            "telephone_number": "281-991-5944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETITT",
        "first_name": "MATTHEW",
        "middle_name": "SEAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-14",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "TX",
            "license": "M2750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MYUTMB 3853003243-COMMERCIAL NUMBER",
            "identifier": "3853003243",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Perfect 20/20 Eyecare, P.a.
• Perry Health & Rehabilitation PC
• Debra Lee Perry, D.C.
• Peter B. Morgan, M.D. P.a.
• Elizabeth Kaye Petitt, FNP
• Darnell D Pettway, MD
• Peyman Pakzaban, MD PA
• PH Squared LLC
• Dang Thanh Pham, M.D.
• Hieu T. Pham, D.O.

• Dermatopathology Physician in Pasadena, TX
• Providers in Pasadena, TX by specialty
• Dermatopathology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.