CHARISSA JOY PETTYJOHN (M.D.) – Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician, NPI 1861614711
Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,231 OBSTETRICS/GYNECOLOGY in MA
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Provider Addresses for CHARISSA JOY PETTYJOHN (M.D.)
19, Peverell Street, Savin Hill, Dorchester, Boston, Suffolk County, Massachusetts, 02125, United States
APT 3
DORCHESTER, MA 02125
Phone: (857) 212-3169
Type: Mailing
Dunkin', 750, Washington Street, Downtown Crossing, Downtown, Boston, Suffolk County, Massachusetts, 02111, United States
BOSTON, MA 02111
Phone: (617) 636-0265
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $22.
Total Amount is formed as General ($22) + Research ($0) + Ownership ($0) = $22.
Last reported payment date: 2023-07-25 • Largest payer in this snapshot: CooperSurgical, Inc. ($22).
Total Amount
$22
General + Research + Ownership
Payments
1
Total payment records
General Amount
$22
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-07-25
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| CooperSurgical, Inc. | $22 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2009-10-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20091013000278 | I | Obstetrics/Gynecology | MA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 02125)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O B S T E T R I C S/ G Y N E C O L O G Y | MA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | CT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MA |
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