Shane Petrites, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A166937 Issued in CA

Practice address

1411 East 31St Street Qic 22123
Oakland, CA 94602

Phone

(510) 437-4564

NPI assigned

Apr 14, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1523664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1275020307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 EAST 31ST STREET QIC 22123",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "94602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 EAST 31ST STREET QIC 22123",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "94602",
            "telephone_number": "510-437-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRITES",
        "first_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-14",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A166937",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy White Peterson, NP
• Sandra Joanne Pethan
• Alana Petland
• Diana R Petoskey
• Maggie Mae Petri, RN
• Harry Petropoulos, M.D
• Ann Margaret Petru, M.D.
• Laura Katherine Petry
• Jenny Ta Pettersen, FNP
• Barbara Petterson, MFT

• Emergency Medicine Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.