NPIMap

Individual provider Active NPI

Scott W Petrescue, MD

  • Family Medicine Physician
  • Thief River Falls, MN
National Provider Identifier
1043302474
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41217 Issued in MN
Practice address
1720 Highway 59 S
Thief River Falls, MN 56701-4331
Phone
(218) 684-4747
NPI assigned
Sep 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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 41217 MN Primary

Addresses

Primary practice location

1720 Highway 59 S
Thief River Falls, MN 56701-4331

Mailing address

1720 Highway 59 S
Thief River Falls, MN 56701-4331
Phone (218) 684-4747

Other identifiers 2

IdentifierTypeStateIssuer
10928MedicaidND
945324500MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20060428000500 MN Practitioner - Family Practice 5890608038 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Health Network NorthGroup PAC ID 8022206663, shared by 16 NPIs, 114 clinicians

Practice addresses (Care Compare)

3001 Sanford Pkwy
Thief River Falls, MN 56701-2700
Phone (218) 683-2725

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.22 of 100Reported as group
Quality
90.28
Promoting interoperability
100
Improvement activities
40
Cost
72.7

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41217MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health Network North CurrentSince Feb 10, 2018 Accepting new patients
Sanford Health Network North Current Accepting new patients
Sanford Health Network North Current Accepting new patients
Sanford Health Network North CurrentSince Feb 10, 2018 Accepting new patients
Sanford Health Network North Past Accepting new patients

Locations

120 Labree Ave S
Thief Rvr Fls, MN 56701
Phone (218) 681-0600

1720 US Highway 59 SE
Thief Rvr Fls, MN 56701
Phone (218) 681-4747

3001 Sanford Pkwy
Thief Rvr Fls, MN 56701
Phone (218) 681-4240

Organizations & group practices 5

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1043302474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 HIGHWAY 59 S",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567014331",
            "telephone_number": "218-684-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 HIGHWAY 59 S",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567014331",
            "telephone_number": "218-684-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRESCUE",
        "first_name": "SCOTT",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-30",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "41217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10928",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "945324500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thief River Falls, MN

Sources for this page

Verify at the official NPI Registry.