JOHN DAVID PETTY, Psy.D. — NPI 1245541705 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1245541705

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

103TC0700X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical

Box 32 Service Location & ZIP+4

68 EARLS WAY, PUTNEY, VT, 05346-8617

✓ 9-Digit EDI 837 ZIP+4 (05346-8617)

Practice Phone & Referral Fax

(802) 387-5011

Fax: (802) 387-2299

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1245541705 (JOHN DAVID PETTY, Psy.D.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1245541705` (NPI-1 Individual Practitioner)
Provider / Legal Name	JOHN DAVID PETTY, Psy.D.
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical NUCC Code: `103TC0700X` (Psychologist, Clinical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	68 EARLS WAY, PUTNEY, VT, 05346-8617
Practice Telephone / Fax	Tel: (802) 387-5011 \| Fax: (802) 387-2299
Administrative Mailing Address	68 EARLS WAY, PUTNEY, VT, 05346-8617
Enumeration & Last Sync	Enumerated: 2010-06-29 \| CMS Record Updated: 2020-01-10

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

68 EARLS WAY, PUTNEY, VT, 05346-8617

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Plain-English Taxonomy & CMS Crosswalk (103TC0700X)

What Does Taxonomy Code 103TC0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TC0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical) • CMS Code 68 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Clinical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JOHN DAVID PETTY, Psy.D.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`103TC0700X` — Psychologist, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical	State: VT \| License: `048.0110630` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JOHN DAVID PETTY, Psy.D. (NPI #1245541705)