Steven John Petrakis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

NM96-117 Issued in NM

Practice address

500 North Mundo
Dulce, NM 87528-2725

Phone

(575) 759-3291

Fax

(575) 759-7294

NPI assigned

Dec 8, 2006

Last updated

Aug 11, 2011By the provider in NPPES

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 4

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dulce Health Center

  • General Acute Care Hospital
  • Dulce, NM
  • NPI 1750388963

  TX

  Medicare reassignment
• Jicarilla IHS Pharmacy

  dba Dulce IHS Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Dulce, NM
  • NPI 1124220900
  NPD (past)
• Santa Ana Health Center

  • Health Service Clinic/Center
  • Bernalillo, NM
  • NPI 1649331323
  NPD (past)
• Santa Ana Health Clinic Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Bernalillo, NM
  • NPI 1154453413
  NPD (past)
• Zia Health Center

  • Health Service Clinic/Center
  • Zia Pueblo, NM
  • NPI 1831250398
  NPD (past)

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313020800000",
    "number": "1265591606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 NORTH MUNDO",
            "city": "DULCE",
            "state": "NM",
            "postal_code": "875281010",
            "telephone_number": "575-759-3291",
            "fax_number": "575-759-7294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 NORTH MUNDO",
            "city": "DULCE",
            "state": "NM",
            "postal_code": "875282725",
            "telephone_number": "575-759-3291",
            "fax_number": "575-759-7294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRAKIS",
        "first_name": "STEVEN",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2011-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "NM96-117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PROVIDER #",
            "identifier": "000S5584",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "K3526",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN #",
            "identifier": "8HN067",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B #",
            "identifier": "HSZ196",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eileen Claire Monyok, PA-C
• Phyllis Diane Morehead, RN
• Northwest Reional Education Coop #2 (Dulce School Based Health Center)
• Amit M Patel, PHARMD
• Darlene Peshlakai Valdez
• Kelly Rae Pettigrew, OPTICIAN LICENSE FL
• Eric J Polczynski, RPH
• Theresa Ann Posey, RN
• Gaylia Dianne Pride, RN
• Marcia Ann Sahmaunt

• Family Medicine Physician in Dulce, NM
• Providers in Dulce, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; 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.