Melissa Petrovic

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

7382 Halite CT
Castle Rock, CO 80108-3023

Phone

(720) 899-2802

NPI assigned

Mar 23, 2021

Sex

Female

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686355200000",
    "number": "1104402866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4340 PEBBLE RIDGE CIR APT 152",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809066531",
            "telephone_number": "701-793-9792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7382 HALITE CT",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801083023",
            "telephone_number": "720-899-2802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4570 Hilton Pkwy",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809073551",
            "country_code": "US",
            "telephone_number": "719-272-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETROVIC",
        "first_name": "MELISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-23",
        "last_updated": "2023-06-10",
        "certification_date": "2023-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144936857",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154022614",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Dean Peterson, MD
• Susan Harper Peterson, B.A.
• Jackson Alexander Petrauskas
• Ashlie Petrilli, D.D.S.
• Dejan Petrovic
• Taylor Mark Pfeifer, PT, DPT
• Mya Pfenning
• Jack Jay Philippe, OD
• Jakalya Phillips
• Jennifer Phillips, OTR/L

• Behavior Technician in Castle Rock, CO
• Providers in Castle Rock, CO by specialty
• Behavior Technician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.