Johanna Petrycki, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

222 Middle Country Rd
Suite 228
Smithtown, NY 11787-2871

Phone

(631) 265-1351

Fax

(631) 265-9363

NPI assigned

Aug 14, 2007

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bobby Buka, M.D., P.C.Group PAC ID 0547351140, 140 clinicians

Marcjonathan Serota MD, P.C.Group PAC ID 7719350073, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Bobby Buka, M.D., P.C.

  • Dermatology Physician
  • New York, NY
  • NPI 1134349954
  Medicare reassignment Care Compare group
• Marcjonathan Serota MD, P.C.

  • Dermatology Physician
  • Bayside, NY
  • NPI 1598481251
  Medicare reassignment Care Compare group
• Bruce E. Katz, MD, PC

  • Specialist
  • Brooklyn, NY
  • NPI 1710127675
  NPD

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223596800000",
    "number": "1154513117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 MIDDLE COUNTRY RD",
            "address_2": "SUITE 228",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872871",
            "telephone_number": "631-265-1351",
            "fax_number": "631-265-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 MIDDLE COUNTRY RD",
            "address_2": "SUITE 228",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872871",
            "telephone_number": "631-265-1351",
            "fax_number": "631-265-9363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRYCKI",
        "first_name": "JOHANNA",
        "name_prefix": "Ms.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-14",
        "last_updated": "2008-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1154513117",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "012251-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Lynn Peterson, LCSW
• Samantha Peterson, NP
• Stephanie Petit
• Uliana Petrova
• Risa Petrucci, M.A.
• Mindy Shera Pfeffer, M.D.
• Janet Sheryl Philbin, LCSW
• Phoenix Nurse Practitioners in Psychiatry, PLLC
• Physical Therapy Associates of Smithtown PC
• Physical Therapy Experience PLLC

• Medical Physician Assistant in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; 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.