NPIMap

Individual provider Active NPI

Michael Petry

  • Family Medicine Physician
  • Crestwood, KY
National Provider Identifier
1003270422
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R4220 Issued in KY
Practice address
6411 Veterans Memorial Pkwy
Crestwood, KY 40014-8698
Phone
(502) 241-8611
Fax
(502) 241-4175
NPI assigned
Apr 12, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X R4220 KY Primary

Addresses

Primary practice location

6411 Veterans Memorial Pkwy
Crestwood, KY 40014-8698

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 559-9407

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mpetry71060@direct.nortonhealthcare.org
FHIR URL https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171120003237 KY Practitioner - Family Practice 2567734924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Louisville School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

6411 Veterans Memorial Pkwy
Crestwood, KY 40014-8698
Phone (502) 241-8611

825 Barret Ave
Louisville, KY 40204-1743
Phone (502) 272-5165

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. CurrentSince Oct 7, 2017 Accepting new patients
Community Medical Associates, Inc. CurrentSince Oct 7, 2017 Accepting new patients
Community Medical Associates, Inc. Family Medicine PastSince Dec 12, 2021 Accepting new patients

Locations

6411 Veterans Memorial Pkwy
Ste 100
Crestwood, KY 40014
Phone (502) 241-8611

6411 Veterans Memorial Pkwy
Crestwood, KY 40014
Phone (502) 241-8611

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

Interoperability endpoints

  • Direct secure messaging: mpetry71060@direct.nortonhealthcare.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1003270422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-559-9407",
            "fax_number": "502-272-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6411 VETERANS MEMORIAL PKWY",
            "city": "CRESTWOOD",
            "state": "KY",
            "postal_code": "400148698",
            "telephone_number": "502-241-8611",
            "fax_number": "502-241-4175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRY",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-12",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "R4220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpetry71060@direct.nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "215 Central Ave Ste 100",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402081450",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "215 Central Ave Ste 100",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402081450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crestwood, KY

Sources for this page

Verify at the official NPI Registry.