John M Petrillo, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

239706 Issued in NY

Practice address

624 McClellan Street
Suite 101
Schenectady, NY 12304-1020

Phone

(518) 382-2260

Fax

(518) 347-5007

NPI assigned

Jul 12, 2006

Last updated

Mar 26, 2009By the provider in NPPES

Sex

Male

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 9

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

New York College of Osteo Medicine of New York Institute of Technology, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ellis HospitalGroup PAC ID 5890607410, 250 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community Hospice, Inc, the Hospice, Albany, NY, CCN 331501
• Ellis Hospital Hospital, Schenectady, NY, CCN 330153

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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

• Ellis Hospital

  • General Acute Care Hospital
  • Schenectady, NY
  • NPI 1487644993
  Medicare reassignment Care Compare group
• Community Care Physicians, PC

  • Family Medicine Physician
  • Albany, NY
  • NPI 1811946775
  NPD (past)
• Community Care Physicians, PLLC

  dba Community Care Family Practice Ballston Spa

  • Family Medicine Physician
  • Ballston Spa, NY
  • NPI 1548541246
  NPD (past)

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

• Ellis Hospital

  • General Acute Care Hospital
  • Schenectady, NY
  • NPI 1487644993
  Care Compare affiliation
• The Community Hospice Inc

  • Community Based Hospice Care Agency
  • Albany, NY
  • NPI 1588631733
  Care Compare affiliation

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238025600000",
    "number": "1033144233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN STREET",
            "address_2": "SUITE 101",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-382-2260",
            "fax_number": "518-347-5007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN STREET",
            "address_2": "SUITE 101",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-382-2260",
            "fax_number": "518-347-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRILLO",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2009-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "239706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "070216000066",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENIOR WHOLE HEALTH",
            "identifier": "200391",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC",
            "identifier": "4148P1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "4149233",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSNENY",
            "identifier": "000412108002",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI HMO",
            "identifier": "111639",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7488829",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02770294",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "10112887",
            "identifier": "CDPHP",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert James Peters, LCSW
• Charles Craig Peterson, M.D.
• Haley Peterson
• Julie Anne Peterson, CMHN
• Lisa F Petraccione, RPA-C
• Joseph A Petrosino, P.A.
• Lisa Petroski, RD
• Wyndi Lois Pettibone, MS CCC-SLP
• Peter I Pfaffenbach, DDS
• Phalanx Med New York, LLC

• Family Medicine Physician in Schenectady, NY
• Providers in Schenectady, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.