Noune Petrosian, PAC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

9885 Issued in MN

Practice address

508 Tenth Street
Worthington, MN 56187-2343

Phone

(507) 372-2921

Fax

(507) 372-1815

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Divine Medical Wellness Center Inc

  • General Practice Physician
  • Fresno, CA
  • NPI 1972920098
  Medicare reassignment

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1013003706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 TENTH STREET",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561872343",
            "telephone_number": "507-372-2921",
            "fax_number": "507-372-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 TENTH STREET",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561872343",
            "telephone_number": "507-372-2921",
            "fax_number": "507-372-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSIAN",
        "first_name": "NOUNE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "9885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00314620",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "132167",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "877938400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer M Oakes, CRNA
• Chioma Blessing Osemwegie, MD
• Maria Conchita Paez-Sievert
• Bharat K Patel, M.D.
• Emily Ruth Penning, MD
• Kelly Jo Phillips, DDS
• Barbara Jean Pieske, LGSW, LICSW
• Jeffrey Alan Pond, PHARMACIST
• Michelle J Poppen, RD
• Prairie Rehabilitation Services, Inc.

• Surgical Physician Assistant in Worthington, MN
• Providers in Worthington, MN by specialty
• Surgical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.