NPIMap

Individual provider Active NPI

Eric Evan Petterson, MD

  • Addiction Medicine (Internal Medicine) Physician
  • Mahanoy City, PA
National Provider Identifier
1245269547
Registry record updated Oct 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
License
MD039636L Issued in PA
Practice address
411 W Pine St
Mahanoy City, PA 17948-2515
Phone
(570) 773-1101
Fax
(570) 773-1103
NPI assigned
Jul 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Internal Medicine) Physician 207RA0401X MD039636L PA Primary
Internal Medicine Physician 207R00000X MD039636L PA

Addresses

Primary practice location

411 W Pine St
Mahanoy City, PA 17948-2515

Mailing address

411 W Pine St
Mahanoy City, PA 17948-2515
Phone (570) 462-1040

Other identifiers 1

IdentifierTypeStateIssuer
0010036980010MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address drpetterson@breakthroughhealthpa.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20050503000144 PA Practitioner - HospitalistPractitioner - Internal Medicine 0749229532 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 S Main St
Shenandoah, PA 17976-2332

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD039636LPAMDAddiction Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eric E. Petterson P.C. Addiction Medicine CurrentSince Jul 1, 2000 Accepting new patients
Eric E. Petterson P.C. Addiction Medicine CurrentSince Jan 1, 1990 Accepting new patients

Locations

4 W Washington St
Shenandoah, PA 17976
Phone (570) 462-1040

218 S Main St
Shenandoah, PA 17976
Phone (570) 462-1470

1 S Main St
Shenandoah, PA 17976
Phone (570) 462-1040

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760659200000",
    "number": "1245269547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W PINE ST",
            "city": "MAHANOY CITY",
            "state": "PA",
            "postal_code": "179482515",
            "telephone_number": "570-462-1040",
            "fax_number": "570-462-1042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W PINE ST",
            "city": "MAHANOY CITY",
            "state": "PA",
            "postal_code": "179482515",
            "telephone_number": "570-773-1101",
            "fax_number": "570-773-1103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSON",
        "first_name": "ERIC",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-01",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "PA",
            "license": "MD039636L",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD039636L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010036980010",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drpetterson@breakthroughhealthpa.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "office email",
            "address_1": "411 w pine st",
            "city": "Mahanoy City",
            "state": "PA",
            "country_code": "US",
            "postal_code": "179482515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mahanoy City, PA

Sources for this page

Verify at the official NPI Registry.