Edward Wayne Petrik, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

P4098 Issued in TX

Practice address

3004 Live Oak St
Round Rock, TX 78681-1238

Phone

(737) 293-0000

NPI assigned

May 12, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 27, 2025 through Nov 27, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1305158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1093007825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3004 LIVE OAK ST",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786811238",
            "telephone_number": "737-293-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3004 LIVE OAK ST",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786811238",
            "telephone_number": "737-293-0000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1841 S Lakeline Blvd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Cedar Park",
            "state": "TX",
            "postal_code": "786134666",
            "country_code": "US",
            "telephone_number": "737-293-0000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRIK",
        "first_name": "EDWARD",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-12",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "TX",
            "license": "P4098",
            "primary": false
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "TX",
            "license": "P4098",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "P4098",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "P4098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan S Peterson, MD
• Sandra Peterson, FNP
• Stephanie Peterson, DPT
• Genita Petralli, AMNA
• Erika Amethyst Petre, BCBA, LBA
• Madison Petrmichl, BCBA
• Bonny Benjamin Petty, PA-C
• Mo Pezeshk, D.D.S.
• Amber Pfertner
• Christie Minhtrang Pham, DO

• Anesthesiology Physician in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Anesthesiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.