Kent A Petrie, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22520 Issued in CO

Practice address

320 Beard Creek Rd Ste 200
Edwards, CO 81632-6426

Phone

(970) 945-2840

Fax

(970) 945-2893

NPI assigned

Jan 23, 2006

Sex

Male

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Mountain Family Health Centers

  • Federally Qualified Health Center (FQHC)
  • Avon, CO
  • NPI 1982328969
  NPD (past)
• VVMC Diversified Services

  • Urgent Care Clinic/Center
  • Avon, CO
  • NPI 1255708053
  NPD (past)

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1265402283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 GILSTRAP CT",
            "address_2": "SUITE 230",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816018735",
            "telephone_number": "970-945-2840",
            "fax_number": "970-945-2893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 BEARD CREEK RD STE 200",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "816326426",
            "telephone_number": "970-945-2840",
            "fax_number": "970-945-2893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "KENT",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "22520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000104567",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Sharree Parsons, LCSW
• Monica L Pattillo
• Peak Dentistry LLC
• Rebecca Kate Percy, MD
• Julie Peterson, PT
• Michael C Pindar, DPT
• Mark Janes Pitcher, DC
• Marina Pitsilos, PMHNP-BC
• Anna J Pradka, CRNA
• Judith A Prather, R.PH

• Family Medicine Physician in Edwards, CO
• Providers in Edwards, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.