Gary Lee Petry, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0428470 Issued in KS

Practice address

1110 Columbine Drive
Holton, KS 66436

Phone

(785) 364-2126

Fax

(785) 364-2801

NPI assigned

Sep 28, 2006

Last updated

Nov 25, 2020By 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 3

Medicare fee-for-service enrollment

Enrolled in KS, CO2 enrollments

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 2

Specialty

Family Practice

Education

University of Kansas School of Med (KC/Wich/Sal), 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Vincent General Hospital DistrictGroup PAC ID 4587574884, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gary.petry.2@16856.direct.athenahealth.com

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.

• St. Vincent General Hospital District

  • Primary Care Clinic/Center
  • Leadville, CO
  • NPI 1497710958
  Medicare reassignment Care Compare group
• Rural Health Resources of Jackson Co Inc

  • Multi-Specialty Clinic/Center
  • Holton, KS
  • NPI 1235238296
  Medicare reassignment NPD
• Rural Health Resources of Jackson Co Inc

  dba Family Practice Associates

  • Rural Health Clinic/Center
  • Wetmore, KS
  • NPI 1003152430
  NPD
• Rural Health Resources of Jackson Co Inc

  dba Family Practice Associates

  • Rural Health Clinic/Center
  • Holton, KS
  • NPI 1639145204

  Family Medicine

  NPD
• Geary County Hospital

  • General Acute Care Hospital
  • Junction City, KS
  • NPI 1063549327
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1073605085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 COLUMBINE DRIVE",
            "city": "HOLTON",
            "state": "KS",
            "postal_code": "66436",
            "telephone_number": "785-364-2126",
            "fax_number": "785-364-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 COLUMBINE DRIVE",
            "city": "HOLTON",
            "state": "KS",
            "postal_code": "66436",
            "telephone_number": "785-364-2126",
            "fax_number": "785-364-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRY",
        "first_name": "GARY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0428470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "80175101",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10039800A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "101003",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Samantha Cruz Rieschick, D.D.S.

• Family Medicine Physician in Holton, KS
• Providers in Holton, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; 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.