Paul M Petelin Sr., MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

5845 Issued in AZ

Practice address

14275 N 87TH St
Ste 110
Scottsdale, AZ 85260-3696

Phone

(480) 905-8485

Fax

(480) 905-7274

NPI assigned

Dec 17, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Center for Dermatology, PLLC

  • Medical Physician Assistant
  • Scottsdale, AZ
  • NPI 1174062673
  NPD (past)

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1124201819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 N 87TH ST",
            "address_2": "STE 110",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852603696",
            "telephone_number": "480-905-8485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14275 N 87TH ST",
            "address_2": "STE 110",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852603696",
            "telephone_number": "480-905-8485",
            "fax_number": "480-905-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETELIN",
        "first_name": "PAUL",
        "middle_name": "M",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-17",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AZ",
            "license": "5845",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "5845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nichole Maria Peru, MA, BCBA, LBA
• Chelsey Pestello, CRNA
• Kristin E Petcher, PA
• Pete N Mellas DMD Ms PLLC
• Anthony John Petelin, M.D.
• Paul M Petelin Jr., MD
• Peter J. Ferrara M.D. P.C.
• Christine Peters
• Claudia M Peters, R.N.
• G Michael Peters, MD

• Surgery Physician in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; 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.