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DR. SHANNA B PETTIE M.D.
NPI 1093978918
Internal Medicine in Jackson, MS

Active since July 10, 2008PECOS EnrolledAccepts Medicare Assignment
911 ELLIS AVE, JACKSON, MS 39209(601) 533-7016 Get Directions Write a Review

NPPES record last updated: July 15, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 20, 2019, Feb 26, 2019 (2 updates tracked since 2019).

About Dr. Shanna B Pettie M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SHANNA B PETTIE M.D. (NPI 1093978918) is an individual internal medicine provider in Jackson, Mississippi, licensed in Mississippi (23730) and active in the NPI registry since July 2008. She is enrolled in Medicare PECOS and is a graduate of Wayne State University School Of Medicine (2008).

NPPES Registry Identity

NPI1093978918
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameDR. SHANNA B PETTIECredential: M.D.
Location Address911 ELLIS AVEJackson, MS 39209-6256
Mailing AddressPo Box 746085Atlanta, GA 30374-6085 · (773) 352-1515
Phone(601) 533-7016
Sole ProprietorNo
Medical School CMSWayne State University School Of MedicineGraduated 2008
Enumeration DateJuly 10, 2008
Last NPPES UpdateJuly 15, 20252 updates tracked since enumeration
NPPES CertifiedJuly 15, 2025
✔ NPI 1093978918 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MS · 23730
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedMilitary Health Care ProviderTaxonomy 171000000X
911 ELLIS AVE, Jackson, MS 39209
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Shanna B Pettie M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3375772072
PECOS Enrollment IDI20150805007147
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 39209 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$120.41 typical visit price
range $51.65 – $159.18
Typical copayment $30.10 (range $12.91 – $39.79)
Most-billed visit code 99204
Established Patient
$92.20 typical visit price
range $16.15 – $129.61
Typical copayment $23.05 (range $4.03 – $32.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BOB HUTCHINS
Internal Medicine
911 ELLIS AVE
JACKSON, MS 39209
Hinds County (601) 533-7016
BARBARA KENDRICK
Nurse Practitioner (Family)
911 ELLIS AVE
JACKSON, MS 39209
Hinds County (601) 533-7016
APRIL LAKESHIA GREEN NP
Nurse Practitioner
911 ELLIS AVE
JACKSON, MS 39209
Hinds County (601) 533-7016
DR. WAYNE C JOHNSON JR. M.D.
Family Medicine
911 ELLIS AVE
JACKSON, MS 39209
Hinds County (601) 533-7016
JOSEPH SAMUEL HUNTER MD
Family Medicine
911 ELLIS AVE
JACKSON, MS 39209
Hinds County (601) 533-7016
MS. CAROLINE V GREEN FNP-C
Nurse Practitioner (Family)
911 ELLIS AVE
JACKSON, MS 39209
Hinds County (601) 533-7016
PENNY D. VANCE FNP-BC
Nurse Practitioner (Family)
911 ELLIS AVE
JACKSON, MS 39209
Hinds County (601) 533-7016
MS. RASHANDRA FISHER LAWS CFNP
Nurse Practitioner (Family)
911 ELLIS AVE
JACKSON, MS 39209
Hinds County (601) 533-7016

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shanna Pettie's NPI number?

The NPI number for Shanna Pettie is 1093978918. It was assigned to this individual provider in the NPPES registry on July 10, 2008.

Where is Shanna Pettie located?

Shanna Pettie practices at 911 Ellis Ave, Jackson, MS 39209. The listed phone number is (601) 533-7016.

What is Shanna Pettie's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Shanna Pettie enrolled in Medicare?

Yes. Shanna Pettie is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Shanna Pettie was last updated on July 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.