Matthew Shane Petrie, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

D72126 Issued in MD

Practice address

3055 Washington Rd
Suite 203
MC Murray, PA 15317-3279

Phone

(724) 260-5424

Fax

(724) 260-5425

NPI assigned

May 30, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

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 1

Specialty

DermatologyAlso: Micrographic Dermatologic Surgery (MDS)

Education

Wake Forest University School of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Commonwealth Dermatology PCGroup PAC ID 2163711920, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BFBHAA

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.

• Commonwealth Dermatology, P.C.

  • Dermatology Physician
  • MC Murray, PA
  • NPI 1609239847
  Medicare reassignment Care Compare group NPD Authorized official
• Zitelli & Brodland PC

  • MOHS-Micrographic Surgery Physician
  • Pittsburgh, PA
  • NPI 1184790099
  NPD (past)
• Derm Associates LLC

  • Dermatology Physician
  • Silver Spring, MD
  • NPI 1649271354
  NPD (past)

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515456000000",
    "number": "1114128808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 WASHINGTON RD",
            "address_2": "SUITE 203",
            "city": "MC MURRAY",
            "state": "PA",
            "postal_code": "153173279",
            "telephone_number": "724-260-5424",
            "fax_number": "724-260-5425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 WASHINGTON RD",
            "address_2": "SUITE 203",
            "city": "MC MURRAY",
            "state": "PA",
            "postal_code": "153173279",
            "telephone_number": "724-260-5424",
            "fax_number": "724-260-5425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "MATTHEW",
        "middle_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2018-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MD",
            "license": "D72126",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "PA",
            "license": "MD438908",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD438908",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MD",
            "license": "D72126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102851711-0002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whitney Pecovish
• Penn Dental Solutions LLC
• Kristen Emily Mestayer Peske, D.O.
• Peters Township School District
• Peters Township Surgery Center, LLC
• Michael Anthony Pezzone, DC
• Shayna Pezzone, DC
• Beth Phillips
• Brianna Marie Phillips, OTR/L
• Carroll L Phillips, DNP, CRNP

• Dermatology Physician in MC Murray, PA
• Providers in MC Murray, PA by specialty
• Dermatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.
• 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.