Samuel R. Pettis, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

MD00017597 Issued in WA

Practice address

742B Boylston Ave E
Seattle, WA 98102-4619

Phone

(000) 000-0000

NPI assigned

Apr 10, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Auburn Imaging Partners LLC

  • Diagnostic Radiology Physician
  • Auburn, WA
  • NPI 1477534246
  NPD (past)
• Seattle Nephrology PLLC

  • Nephrology Physician
  • Shoreline, WA
  • NPI 1306055926
  NPD (past)

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196035200000",
    "number": "1922061191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742B BOYLSTON AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981024619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742B BOYLSTON AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981024619",
            "telephone_number": "000-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "SAMUEL",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2007-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WA",
            "license": "MD00017597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gail D Petteruti, PAC
• Charles Q.S. Petteys, LMP
• Kiley A Pettiford
• Gail Y. Pettis, DDS, MMED.SC.
• Kaleigh Pettis, LMFT
• Casandra Petty
• Charles Neuman Petty, MD
• Jennifer Petty
• Theophile Kouam Peumeu, RN
• Kye Peven, ND, DSOM, EAMP

• Nephrology Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Nephrology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.