MATTHEW PETTENGILL DPM
NPI 1215046974
Podiatrist - Foot & Ankle Surgery in Phoenix, AZ

Q: What is Matthew Pettengill's NPI number?

The NPI number for Matthew Pettengill is 1215046974. It was assigned to this individual provider in the NPPES registry on August 29, 2006.

Q: What is Matthew Pettengill's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.

Active since August 29, 2006PECOS EnrolledAccepts Medicare Assignment

4212 N 16TH ST, PHOENIX, AZ 85016(602) 263-1200(602) 200-5383 Get Directions Write a Review

NPPES record last updated: July 29, 2011. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Matthew Pettengill Dpm NPPES

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

MATTHEW PETTENGILL DPM (NPI 1215046974) is an individual foot & ankle surgery provider in Phoenix, Arizona, licensed in Pennsylvania (SC004785L) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1997).

NPPES Registry Identity

NPI1215046974

Entity TypeIndividualMale

Primary Taxonomy213ES0103X

Provider Legal NameMATTHEW PETTENGILLCredential: DPM

Location Address4212 N 16TH STPhoenix, AZ 85016-5319

Mailing AddressPo Box 31001-0698Pasadena, CA 91110-0698 · (602) 263-1200 · Fax (602) 200-5383

Phone(602) 263-1200

Fax(602) 200-5383

Sole ProprietorNo

Medical School CMSOtherGraduated 1997

Enumeration DateAugust 29, 2006

Last NPPES UpdateJuly 29, 2011

✔ NPI 1215046974 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatrist · Foot & Ankle SurgeryPodiatric Medicine & Surgery Service Providers

Taxonomy Code213ES0103X

Licenses✔ Licensed in PA · SC004785L✔ Licensed in ME · POD1049

4212 N 16TH ST, Phoenix, AZ 85016

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Other Identifiers 5

Medicare UPINV00511AZ

Medicare ID-Type Unspecified8HF086AZ · Part B

OtherAZ0307600AZ · Bcbs

Medicaid046148AZ

Medicare OSCAR/certification030078AZ

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Matthew Pettengill Dpm 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 ID1557333952

PECOS Enrollment IDI20060321000424

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.

Medicare Billing Reassignments

Medicare enrollment records show Matthew Pettengill reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Dhew Ind Hlth Sv Hlth Svs & Mntl Hlth Adm

Same address

Public Health or Welfare

4212 N 16TH ST
Phoenix, AZ 85016

Reassigned Medicare billing, Texas enrollment
599 clinicians in this Medicare group

NPI 1083643738 (602) 263-1200

Dhhs Phs Ihs Phoenix Area

158 mi

Clinic/Center

401 PICACHO ROAD
Winterhaven, CA 92283

Reassigned Medicare billing, Texas enrollment
59 clinicians in this Medicare group

NPI 1265719918 (760) 572-4100

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

59 services38 patients

Other Providers at the Same Location NPPES 20

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

WENDY RAZO

Registered Nurse (Obstetric, High-Risk)