SAMUEL R. PETTIS M.D.
NPI 1922061191
Internal Medicine - Nephrology in Seattle, WA

Q: What is Samuel Pettis's NPI number?

The NPI number for Samuel Pettis is 1922061191. It was assigned to this individual provider in the NPPES registry on April 10, 2006.

Q: What is Samuel Pettis's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Pettis was last updated on November 26, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.

Active since April 10, 2006PECOS Enrolled

742B BOYLSTON AVE E, SEATTLE, WA 98102(000) 000-0000 Get Directions Write a Review

NPPES record last updated: November 26, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Samuel R. Pettis M.d. NPPES

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

SAMUEL R. PETTIS M.D. (NPI 1922061191) is an individual nephrology provider in Seattle, Washington, licensed in Washington (MD00017597) and active in the NPI registry since April 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1922061191

Entity TypeIndividualMale

Primary Taxonomy207RN0300X

Provider Legal NameSAMUEL R. PETTISCredential: M.D.

Location Address742B BOYLSTON AVE ESeattle, WA 98102-4619

Mailing Address742b Boylston Ave ESeattle, WA 98102-4619

Phone(000) 000-0000

Sole ProprietorNo

Enumeration DateApril 10, 2006

Last NPPES UpdateNovember 26, 2007

✔ NPI 1922061191 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians

Taxonomy Code207RN0300X

License✔ Licensed in WA · MD00017597

Definition

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

742B BOYLSTON AVE E, Seattle, WA 98102

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Other Identifiers 1

Medicare UPINA06033WA

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel R. Pettis M.d. 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98102 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

$143.76 typical visit price

range $63.67 – $189.37

Typical copayment $35.94 (range $15.91 – $47.34)

Most-billed visit code 99204

Established Patient

$111.00 typical visit price

range $21.12 – $155.00

Typical copayment $27.75 (range $5.28 – $38.75)

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.

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 Samuel Pettis's NPI number?

The NPI number for Samuel Pettis is 1922061191. It was assigned to this individual provider in the NPPES registry on April 10, 2006.

Where is Samuel Pettis located?

Samuel Pettis practices at 742B Boylston Ave E, Seattle, WA 98102. The listed phone number is (000) 000-0000.

What is Samuel Pettis's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Is Samuel Pettis enrolled in Medicare?

Yes. Samuel Pettis is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Samuel Pettis was last updated on November 26, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.