SCOTT S PETTY (NPI# 1881754901) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881754901 |
| Entity Type | Individual |
| Full Name | SCOTT S PETTY |
| Credential | MD |
| Practice Address |
1777 E Clark St Suite 330 Pocatello ID 83201-3357 |
| Practice Telephone | 2082331033 |
| Mailing Telephone | 2082331033 |
| Mailing Fax Number | 2082331033 |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
M4325 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE CROSS | 43257 | 01 | |
| BLUE SHIELD | 0000100000107 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124042197 | Scott M Petty | Radiology | 534 Biltmore Ave, Asheville, NC 28801-4610 | 2006-07-26 |
| Street Address |
1777 E CLARK ST SUITE 330 |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-3357 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487688990 | Brent Christensen | Podiatrist | 1777 E Clark St, Suite 220, Pocatello, ID 83201-3357 | 2006-07-10 |
| 1831712207 | Tanner Saxton | Counselor | 1777 E Clark St, Pocatello, ID 83201-3357 | 2020-05-20 |
| 1598197857 | Christensen Foot & Ankle Clinic | Podiatrist | 1777 E Clark St, Suite 220, Pocatello, ID 83201-3357 | 2013-08-08 |
| 1598077562 | Life Change Associates, PC | Counselor | 1777 E Clark St, Suite 330, Pocatello, ID 83201-3357 | 2010-07-07 |
| 1154431542 | Deric V Ravsten | Psychiatry & Neurology | 1777 E Clark St, Suite 330, Pocatello, ID 83201-3357 | 2006-08-30 |
| 1487760450 | Dwight Romriell | Dentist | 1777 E Clark St, Suite 240, Pocatello, ID 83201 | 2006-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578667739 | Mary Elizabeth Gerard | Psychiatry & Neurology | 333 N 18th Ave Ste B4, Pocatello, ID 83201 | 2006-09-11 |
| 1265670061 | M Elizabeth Gerard Md Pllc | Psychiatry & Neurology | 333 N 18th Ave, Ste B4, Pocatello, ID 83201 | 2009-02-02 |
| 1700807260 | Richard D Karem | Psychiatry & Neurology | 777 Hospital Way, Pocatello, ID 83201-5175 | 2006-07-21 |
| 1043219694 | Robert Michael Kennedy | Psychiatry & Neurology | 777 Hospital Way, G15, Pocatello, ID 83201-5175 | 2005-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508286188 | Nina Sienna Bozinov | Psychiatry & Neurology | 700 W Ironwood Dr Ste 158, Coeur D Alene, ID 83814-4404 | 2014-04-22 |
| 1922449453 | Sarita Said Said | Psychiatry & Neurology | 2400 W A St, Moscow, ID 83843-4902 | 2013-07-12 |
| 1386903359 | Daniel B Simmons | Psychiatry & Neurology | 1072 N Liberty St Ste 303, Boise, ID 83704 | 2012-05-11 |
| 1053678342 | Daniel Clark Abenroth | Psychiatry & Neurology | 9th Floor -- Neurosciences, 190 E Bannock St., Boise, ID 83712-8905 | 2012-04-12 |
| 1427294545 | Thomas E Henson | Psychiatry & Neurology | 3183 S Temperance Way, Boise, ID 83706-5703 | 2008-12-18 |
| 1235381948 | Karin Lindholm, D.o. | Psychiatry & Neurology | 901 N Curtis Rd Ste 403, Boise, ID 83706-1342 | 2008-10-14 |
| 1548452683 | Sergei V Kashirny | Psychiatry & Neurology | 125 E Idaho St Ste 300, Neurology, Boise, ID 83712-6256 | 2007-08-13 |
| 1316090426 | Affiliated Neurologists Pllc | Psychiatry & Neurology | 338 6th St, Suite 102, Lewiston, ID 83501-2419 | 2007-01-19 |
| 1437252723 | Eastern Idaho Neurological Associates Pa | Psychiatry & Neurology | 2353 Coronado Drive, Idaho Falls, ID 83404 | 2006-09-05 |
| 1043249964 | Martha A Cline | Psychiatry & Neurology | 3875 E Overland Road, Meridian, ID 83642 | 2006-07-02 |
| Find all providers with the same taxonomy | ||||
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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.