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DR. COLTON RYAN PETTY MD
NPI 1629743083
Student in an Organized Health Care Education/Training Program in Knoxville, TN

Active since August 09, 2021PECOS Enrolled
1924 ALCOA HWY # U-107, KNOXVILLE, TN 37920(901) 448-5529 Get Directions Write a Review

NPPES record last updated: March 26, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Colton Ryan Petty Md NPPES

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

DR. COLTON RYAN PETTY MD (NPI 1629743083) is an individual student in an organized health care education/training program in Knoxville, Tennessee and active in the NPI registry since August 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1629743083
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. COLTON RYAN PETTYCredential: MD
Location Address1924 ALCOA HWY # U-107Knoxville, TN 37920-1511
Mailing Address910 Madison Ave Ste 1002Memphis, TN 38103-3487 · (901) 448-5529
Phone(901) 448-5529
Sole ProprietorNo
Enumeration DateAugust 9, 2021
Last NPPES UpdateMarch 26, 2024
NPPES CertifiedMarch 26, 2024
✔ NPI 1629743083 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Also ListedGeneral PracticeTaxonomy 208D00000X · License 68958 (TN)
1924 ALCOA HWY # U-107, Knoxville, TN 37920
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Colton Ryan Petty Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignment

Medicare enrollment records show Colton Petty reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Signify Health Medical Associates, PLLC
765 mi
General Practice
4055 VALLEY VIEW LN STE 700
Dallas, TX 75244
  • Reassigned Medicare billing, Tennessee enrollment
  • 528 clinicians in this Medicare group
NPI 1750845863 (972) 715-3800

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

Other Providers at the Same Location NPPES 8

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

LUKE MAGLICH MD
Student in an Organized Health Care Education/Training Program
1924 ALCOA HWY # U-107
KNOXVILLE, TN 37920
Knox County (865) 305-8685
MADISON SHADOWENS
Student in an Organized Health Care Education/Training Program
1924 ALCOA HWY # U-107
KNOXVILLE, TN 37920
Knox County (865) 305-8685
DR. PAUL ALLEN MILLER MD
Student in an Organized Health Care Education/Training Program
1924 ALCOA HWY # U-107
KNOXVILLE, TN 37920
Knox County (865) 305-8685
KELSIE CHERRY DO
Student in an Organized Health Care Education/Training Program
1924 ALCOA HWY # U-107
KNOXVILLE, TN 37920
Knox County (865) 305-8685
MATTHEW WILSON BOUNDS MD
Student in an Organized Health Care Education/Training Program
1924 ALCOA HWY # U-107
KNOXVILLE, TN 37920
Knox County (865) 305-8685
CHAD ALLEN MEADOWS MD
Student in an Organized Health Care Education/Training Program
1924 ALCOA HWY # U-107
KNOXVILLE, TN 37920
Knox County (865) 305-8685
DR. JARED WILLIAM PEACOCK MD
Radiology (Neuroradiology)
1924 ALCOA HWY # U-107
KNOXVILLE, TN 37920
Knox County (865) 305-8685
NOAH CHRISTOPHER HIATT MD
Student in an Organized Health Care Education/Training Program
1924 ALCOA HWY # U-107
KNOXVILLE, TN 37920
Knox County (865) 305-8685

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 Colton Petty's NPI number?

The NPI number for Colton Petty is 1629743083. It was assigned to this individual provider in the NPPES registry on August 9, 2021.

Where is Colton Petty located?

Colton Petty practices at 1924 Alcoa Hwy # U-107, Knoxville, TN 37920. The listed phone number is (901) 448-5529.

What is Colton Petty's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Colton Petty enrolled in Medicare?

Yes. Colton Petty is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Colton Petty's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Colton Petty reassigns Medicare benefits to Signify Health Medical Associates, PLLC (Dallas, TX). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Colton Petty's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Colton Petty was last updated on March 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.