Michael Anthony Petrillo, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1966 Issued in SC

Practice address

157 William Hilton Pkwy
Hilton Head Island, SC 29926-5218

Phone

(843) 842-2273

NPI assigned

Aug 16, 2013

Last updated

Nov 6, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 SC, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mpetrillo40206@directmcleodehealth.org

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.

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• Acs Primary Care Physicians - Southeast PC

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• NMB Mobile Urgent Care, LLC

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  NPD (past)
• Southern Living Emergency Physicians LLC

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  NPD (past)

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

{
    "created_epoch": "1376611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541462400000",
    "number": "1073946745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21372",
            "city": "HILTON HEAD ISLAND",
            "state": "SC",
            "postal_code": "299251372",
            "telephone_number": "438-422-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 WILLIAM HILTON PKWY",
            "city": "HILTON HEAD ISLAND",
            "state": "SC",
            "postal_code": "299265218",
            "telephone_number": "843-842-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "907 LaMar Alexander Pkwy",
            "address_purpose": "LOCATION",
            "city": "Maryville",
            "state": "TN",
            "postal_code": "378045015",
            "country_code": "US",
            "telephone_number": "865-977-4602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRILLO",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-16",
        "last_updated": "2018-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTH CAROLINA BOARD OF MEDICAL EXAMINER",
            "identifier": "1966",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Peach, RN
• Kristin Denise Perilli, OTR/L
• Abbigail Kathleen Peters, L.AC.
• Joanne Peterson, ED.D
• Ryan O Petrikas
• William I Petty II, M.D.
• David Allen Phillips, MD
• Raleigh Phillips, D.C.
• Katherine B Philpott, DPT
• Natalie Rene Phongam, DPT, PT

• Physician Assistant in Hilton Head Island, SC
• Providers in Hilton Head Island, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.