NPIMap

Individual provider Active NPI

Kimberly A Petruso, DO

  • Family Medicine Physician
  • Boyertown, PA
National Provider Identifier
1043285703
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS009953L Issued in PA
Practice address
23 N Walnut St
Boyertown, PA 19512-1467
Phone
(610) 367-2259
Fax
(610) 367-0505
NPI assigned
Feb 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS009953L PA Primary

Addresses

Primary practice location

23 N Walnut St
Boyertown, PA 19512-1467

Mailing address

1601 Medical Dr
Pottstown, PA 19464-3241
Phone (610) 327-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20040416000586 PA Practitioner - Family Practice 6901891290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

23 N Walnut St
Boyertown Medical Associates
Boyertown, PA 19512-1736
Phone (610) 367-2259

Hospital & facility affiliations

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: kimberlypetruso@pmsi.allscriptsdirect.net

Organizations & group practices 1

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1043285703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 MEDICAL DR",
            "city": "POTTSTOWN",
            "state": "PA",
            "postal_code": "194643241",
            "telephone_number": "610-327-4200",
            "fax_number": "610-327-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 N WALNUT ST",
            "city": "BOYERTOWN",
            "state": "PA",
            "postal_code": "195121467",
            "telephone_number": "610-367-2259",
            "fax_number": "610-367-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSO",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS009953L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boyertown, PA

Sources for this page

Verify at the official NPI Registry.