DR. BENJAMIN D PETTY (NPI# 1659660967) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659660967 |
| Entity Type | Individual |
| Full Name | DR. BENJAMIN D PETTY |
| Credential | MD |
| Practice Address |
1701 N Senate Blvd Room Dg412 Indianapolis IN 46202-1239 |
| Mailing Address |
250 N Shadeland Ave Ste 130 Provider Enrollment Indianapolis IN 46219-4959 |
| Practice Telephone | 3179623886 |
| Practice Fax Number | 3179635492 |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2016-02-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 01071387A | IN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201100880 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518252105 | Benjamin Martin Petty | Family Medicine | 120 William Penn Plz, Durham, NC 27704-2150 | 2011-06-13 |
| Street Address |
1701 N SENATE BLVD ROOM DG412 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46202-1239 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073501235 | Lara Jane Pesavento | Anesthesiology | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2005-10-12 |
| 1508475526 | Wade Everett Oliver | Nurse Practitioner | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2020-07-27 |
| 1538778600 | Marleana Leann Groh | Nurse Practitioner | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2020-07-24 |
| 1982225447 | Saily Jacqueline Guerra | Dietitian, Registered | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2020-05-06 |
| 1013538826 | Paige Randolph | Nurse Practitioner | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2020-05-04 |
| 1780213926 | John Peacock | Student in an Organized Health Care Education/Training Program | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2020-04-08 |
| 1295354462 | Kylie J Miller | Student in an Organized Health Care Education/Training Program | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2020-04-08 |
| 1962031492 | Kristina Lynn Mathey | Counselor | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2020-04-06 |
| 1023647674 | Lindsay Nicole Troyer | Student in an Organized Health Care Education/Training Program | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2020-04-06 |
| 1548894686 | Courtney Leanne Kroes | Social Worker | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2020-02-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386886 | Sara Brooke Horn | Registered Nurse | 1801 N Senate Ave Ste 3300, Indianapolis, IN 46202 | 2020-11-04 |
| 1013521905 | Zachary Camden Grimes | Registered Nurse | 720 Eskenazi Avenute, Indianapolis, IN 46202 | 2020-09-08 |
| 1790314045 | Scott C Mitchell II | Student in an Organized Health Care Education/Training Program | Indiana University School of Medicine Dept of Neurosurg, 355 W. 16th St, Gh 5100, Indianapolis, IN 46202 | 2020-04-07 |
| 1053940676 | James Patrick Kelly Iv | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr., Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1124657697 | Betsy Wilson Stevens | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Drive, Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1093340580 | Brian T Edmonds | Social Worker | Sandra Eskenazi Mental Health Center, 1700 N Illinois St, Indianapolis, IN 46202 | 2020-03-05 |
| 1326683210 | Lindsay Nicole Rich | Nurse Practitioner | 1800 N Senate Ave, Indianapolis, IN 46202 | 2019-11-14 |
| 1427693670 | Ronald Mcdonald House Charities of Central Indiana | Voluntary or Charitable | 435 Limestone Street, Indianaplois, IN 46202 | 2019-11-12 |
| 1790344760 | Kirsten Denise Leaberry | Student in an Organized Health Care Education/Training Program | Iu Health Neuroscience Center, Goodman Hall, 355 West 16th Street, Indianapolis, IN 46202 | 2019-06-12 |
| 1679138093 | Chris Olson Jr. | Student in an Organized Health Care Education/Training Program | 1701 N. Senate Blvd, Ag012, Indianapolis, IN 46202 | 2019-05-02 |
| Find all providers in zip 46202 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508358128 | Antonino Bucca | Emergency Medicine | 720 Eskenazi Ave Bldg 3, Indianapolis, IN 46202-5187 | 2018-05-30 |
| 1124518931 | Evan Mitchell Landry Tomkiewicz | Emergency Medicine | 720 Eskenazi Ave Fl Ft3, Indianapolis, IN 46202-5187 | 2018-05-16 |
| 1114307063 | Grant Fabian Chernoby | Emergency Medicine | 701 N Senate Ave # B401, Indianapolis, IN 46202-3111 | 2015-06-05 |
| 1508203514 | Mark Liao | Emergency Medicine | 1701 N Senate Blvd Rm Ag012, Indianapolis, IN 46202-1239 | 2013-05-30 |
| 1003157322 | Medexpress Urgent Care PC - Indiana | Emergency Medicine | 10863 E Washington St, Indianapolis, IN 46229-2615 | 2013-03-12 |
| 1164763744 | Medexpress Urgent Care PC - Indiana | Emergency Medicine | 4903 S Emerson Ave, Indianapolis, IN 46203-5938 | 2013-03-07 |
| 1205199379 | Damien T Berry | Emergency Medicine | 6335 S East St, Indianapolis, IN 46227-7112 | 2012-06-22 |
| 1972886422 | Barber Hospital LLC | Emergency Medicine | 8125 Knue Rd, Indianapolis, IN 46250-1936 | 2011-09-21 |
| 1225321797 | Seth Benjamin Langsam | Emergency Medicine | 1120 W Michigan St, Cl 260, Indianapolis, IN 46202-5209 | 2011-05-17 |
| 1538480777 | Stephanie M Gardner | Emergency Medicine | 5262 Carrollton Ave, Indianapolis, IN 46220-3181 | 2010-06-22 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46202 |
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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.