Mark a. Petroff, MD. PC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

07-1550 Issued in OR

Legal business name

MARK A. PETROFF, MD. PC

Practice address

17720 Jean Way Ste 100
Lake Oswego, OR 97035-5575

Phone

(503) 635-4886

Fax

(503) 635-1655

NPI assigned

Nov 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mark A Petroff, MDNPI 1528068129

Title

President

Phone

(503) 607-1304

Specialties & licenses 1

Addresses

Other names 1

• Petroff Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Ambulatory surgical center certification: CCN 38C0001057

Legal name

Petroff Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jan 23, 2004

Last certification

Dec 17, 2019

Ownership / control type

Proprietary

Facility address

17720 Jean Way, Suite 100
Lake Oswego, OR 97035

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Mark a. Petroff, MD PC

  • Plastic Surgery Physician
  • Lake Oswego, OR
  • NPI 1144365941

  5890709059

  Same PAC ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark A. Petroff, M.D.

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Lake Oswego, OR
  • NPI 1528068129
  NPD Authorized official

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

{
    "created_epoch": "1163808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1275607616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17720 JEAN WAY STE 100",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970355575",
            "telephone_number": "503-635-4886",
            "fax_number": "503-635-1655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17720 JEAN WAY STE 100",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970355575",
            "telephone_number": "503-635-4886",
            "fax_number": "503-635-1655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK A. PETROFF, MD. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-18",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "PETROFF",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-607-1304",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OR",
            "license": "07-1550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petroff Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer March, MD, MS
• Sabrina J. Marcus, DC
• Margaret a Hewitt MD PC
• Marion J Darling MDPC
• Mark a. Petroff, MD PC
• Mark Weston, MD, LLC
• Marla Klein, MD LLC
• Jennifer Maronek, OT
• Claire Anna Marquez, DPT
• Dennis Alberto Marquez, APRN

• Ambulatory Surgical Clinic/Center in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.