NPIMap

Individual provider Active NPI

Adam Michael Petry, PA-C

  • Physician Assistant
  • Cleveland, OH
National Provider Identifier
1154064830
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.008229RX Issued in OH
Practice address
11100 Euclid Ave
Cleveland, OH 44106-1716
Phone
(216) 844-3722
NPI assigned
Apr 19, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 50.008229RX OH Primary

Addresses

Primary practice location

11100 Euclid Ave
Cleveland, OH 44106-1716

Mailing address

11100 Euclid Ave
Cleveland, OH 44106-1716
Phone (216) 844-3722

Other practice location 1

275 Eastland Rd
Berea, OH 44017-2005
Phone (440) 826-8016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230918002037 OH Practitioner - Physician Assistant 5294199709 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Hospitals Cleveland Medical CenterGroup PAC ID 3274431879, 123 clinicians
University Hospitals Medical Group IncGroup PAC ID 4789682493, 2,248 clinicians

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716
Phone (216) 844-8447

Hospital & facility affiliations

  • Uh Cleveland Medical Center Hospital, Cleveland, OH, CCN 360137
  • Lake Health Hospital, Concord, OH, CCN 360098
  • University Hospitals Ahuja Medical Center Hospital, Beachwood, OH, CCN 360359
  • University Hospitals Portage Medical Center Hospital, Ravenna, OH, CCN 360078
  • Uhhs Memorial Hospital of Geneva Hospital, Geneva, OH, CCN 361307

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
50.008229RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospitals Cleveland Medical Center Physician Assistant CurrentSince Jul 31, 2023 Accepting new patients
University Hospitals Cleveland Medical Center CurrentSince Jul 31, 2023 Accepting new patients
University Hospitals Medical Group Inc CurrentSince Dec 1, 2025 Accepting new patients
Baldwin Wallace University PastSince Apr 1, 2022 Accepting new patients

Locations

11100 Euclid Ave
Cleveland Heights, OH 44106

Interoperability endpoints

  • Direct secure messaging: apetry228697@ehrdirect.uhhospitals.org

Organizations & group practices 4

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1154064830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061716",
            "telephone_number": "216-844-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061716",
            "telephone_number": "216-844-3722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "275 Eastland Rd",
            "address_purpose": "LOCATION",
            "city": "Berea",
            "state": "OH",
            "postal_code": "440172005",
            "country_code": "US",
            "telephone_number": "440-826-8016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRY",
        "first_name": "ADAM",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-19",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.008229RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.