James Patrick Petrusich, DOCTOR OF AUDIOLOGY

Primary specialty

AudiologistTaxonomy code 231H00000X

License

23599 Issued in OR

Practice address

1815 E 19TH St
Suite 1
The Dalles, OR 97058-3385

Phone

(541) 298-8676

Fax

(541) 298-7746

NPI assigned

Apr 19, 2012

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 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mid-Columbia Medical Center

  • General Practice Physician
  • The Dalles, OR
  • NPI 1053409599
  Medicare reassignment NPD
• Healthcare for the Mid-Columbia Region

  • Emergency Medicine Physician
  • The Dalles, OR
  • NPI 1497797856
  NPD
• Mid-Columbia Medical Center

  • Rural Health Clinic/Center
  • The Dalles, OR
  • NPI 1154351336
  NPD (past)
• Mid-Columbia Medical Center

  • Rural Health Clinic/Center
  • The Dalles, OR
  • NPI 1407887052
  NPD (past)
• Mid-Columbia Medical Center

  • Multi-Specialty Clinic/Center
  • The Dalles, OR
  • NPI 1992094817
  NPD (past)

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

{
    "created_epoch": "1334793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1073870689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 E 19TH ST",
            "address_2": "SUITE 1",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583385",
            "telephone_number": "541-298-8676",
            "fax_number": "541-298-7746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 E 19TH ST",
            "address_2": "SUITE 1",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583385",
            "telephone_number": "541-298-8676",
            "fax_number": "541-298-7746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSICH",
        "first_name": "JAMES",
        "middle_name": "PATRICK",
        "credential": "DOCTOR OF AUDIOLOGY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-19",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OR",
            "license": "23599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01627946",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Ray Perkins, OD
• David S. Perry, D.D.S.
• Peter A Peruzzo, MD
• Elizabeth M Pesco
• Cheyenne Peterson
• Jayme Pettibone
• Jordan Ashley Phelps
• Courtney Phillips, ATC
• Tara A Phillips
• Kathleen S Pickering, PAC

• Audiologist in The Dalles, OR
• Providers in The Dalles, OR by specialty
• Audiologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.