MATTHEW PETTENGILL (NPI# 1215046974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215046974 |
| Entity Type | Individual |
| Full Name | MATTHEW PETTENGILL |
| Credential | DPM |
| Practice Address |
4212 N 16th St Phoenix AZ 85016-5319 |
| Mailing Address |
Po Box 31001-0698 Pasadena CA 91110-0698 |
| Practice Telephone | 6022631200 |
| Practice Fax Number | 6022005383 |
| Mailing Telephone | 6022631200 |
| Mailing Fax Number | 6022005383 |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2011-07-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
SC004785L | PA | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
POD1049 | ME | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 046148 | 05 | |
| AZ | BCBS | AZ0307600 | 01 |
| Street Address |
4212 N 16TH ST |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85016-5319 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184627648 | Judy Marie Pinsonneault | Family Medicine | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2005-05-27 |
| 1568071348 | Christopher Tran | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2020-07-28 |
| 1659980480 | Corinne Easterling | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2020-07-28 |
| 1598383192 | Tamika Howard | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2020-07-09 |
| 1659901544 | Joseph Maloy | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2020-01-20 |
| 1437709680 | Kymberly Sue Ludwig | Pharmacist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2019-09-18 |
| 1962052746 | Jamie C Wilson | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2019-09-13 |
| 1427602721 | Jonathon Andrew Marquez | Respiratory Therapist, Certified | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2019-07-25 |
| 1700441664 | Douglas Edward Henry | Physical Therapist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2019-05-07 |
| 1982189205 | Rachael Renina Hunter Edwards | Psychologist | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2018-10-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992705 | Heatheranne Baker-oldfield | Counselor | 2415 E Camelback Rd Ste 700, Phoenix, AZ 85016 | 2020-11-06 |
| 1780215681 | Sip Home Systems - Mesa LLC | Home Health | 24th At Camelback, 2375 E. Camelback Rd., Suite 600, Phoenix, AZ 85016 | 2020-01-29 |
| 1760945588 | Wei Wei | Student in an Organized Health Care Education/Training Program | Phoenix Children's Hospital 1919 E. Thomas Rd., Phoenix, AZ 85016 | 2019-04-09 |
| 1942765623 | Grace Hatfield | Dietitian, Registered | Phoenix Childrens Hospital 1919 E Thomas Rd, Phoenix, AZ 85016 | 2019-02-06 |
| 1861977027 | Dawn Yvette Lima | Occupational Therapy Assistant | 3128 E Cheery Ln, Phoenix, AZ 85016 | 2018-10-03 |
| 1720583685 | Kristin Pauline Hicklin | Registered Nurse | 2930 E Camelback Rd Ste 100, Phoenix, AZ 85016 | 2018-03-24 |
| 1588181622 | Taness Eyre Billington | Pharmacist | 1625 E. Camelback Rd., Phoenix, AZ 85016 | 2017-08-29 |
| 1093239048 | Emma Ross | Psychologist | 1919 E Thomas Rd Bldg 4th, Phoenix, AZ 85016 | 2017-08-01 |
| 1609396985 | Mohammed Waseemuddin | Student in an Organized Health Care Education/Training Program | Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016 | 2017-06-27 |
| 1144777632 | Amanda Mazerall | Occupational Therapist | 4333 N 24th Street, Apartment 223, Phoenix, AZ 85016 | 2016-09-01 |
| Find all providers in zip 85016 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285155127 | Priyanka Begur | Podiatrist | 1701 E Thomas Rd Ste 201, Phoenix, AZ 85016-7674 | 2017-06-30 |
| 1861808917 | Amanda Sarah Lernor | Podiatrist | 16841 N 31st Ave Ste 134, Phoenix, AZ 85053-3057 | 2014-07-09 |
| 1275949224 | Alexander D Garza | Podiatrist | 3101 E Shea Blvd Ste 220, Phoenix, AZ 85028 | 2014-07-09 |
| 1790195964 | Melissa Jo Chrisman | Podiatrist | 13838 S 46th Pl Ste 210, Phoenix, AZ 85044-7803 | 2014-04-28 |
| 1669812855 | Zachary Anthony Flynn | Podiatrist | 11209 N Tatum Blvd Ste 100, Phoenix, AZ 85028-3000 | 2013-07-02 |
| 1316290893 | Katherine Edithe Kennedy | Podiatrist | 1728 W Glendale Ave Ste 100, Phoenix, AZ 85021-8862 | 2012-10-20 |
| 1790044261 | Shylaja N Arya | Podiatrist | 3104 E Indian School Rd Ste 110, Phoenix, AZ 85016-6873 | 2012-05-03 |
| 1811135817 | Bryan James Roth | Podiatrist | 2601 E Roosevelt Ave, Phoenix, AZ 85008-4973 | 2009-01-29 |
| 1548440936 | Arizona Foot & Ankle Care, P.C. | Podiatrist | 3201 W Peoria Ave Ste A200, Phoenix, AZ 85029-4699 | 2007-11-14 |
| 1689793895 | Kelvin S Crezee Dpm PC | Podiatrist | 15810 S 45th St Ste 190, Phoenix, AZ 85048-7697 | 2007-03-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.