NPIMap

Individual provider Active NPI

Craig John Petry, M.D.

  • Family Medicine Physician
  • Lynchburg, VA
National Provider Identifier
1285657213
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101059194 Issued in VA
Practice address
102 Archway CT
Lynchburg, VA 24502-2889
Phone
(434) 237-3664
Fax
(434) 237-3711
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101059194 VA Primary

Addresses

Primary practice location

102 Archway CT
Lynchburg, VA 24502-2889

Mailing address

102 Archway CT
Lynchburg, VA 24502-2889
Phone (434) 237-3664

Other identifiers 1

IdentifierTypeStateIssuer
146316OtherVAANTHEM BLUE CROSS AND BLU

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20041109000739 VA Practitioner - Family Practice 3375506504 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Therapies of Roanoke, Inc.Group PAC ID 3375710619, shared by 5 NPIs, 272 clinicians

Practice addresses (Care Compare)

102 Archway CT
Lynchburg, VA 24502-2889
Phone (434) 237-3664

216 Amelon SQ
Suite 7
Madison Heights, VA 24572-5981
Phone (434) 225-4210

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
33.74 of 100Reported as individual
Quality
25
Improvement activities
0
Cost
79.14

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101059194VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wyndhurst Family Medicine, P.C. Family Medicine CurrentSince Nov 1, 2004 Accepting new patients

Locations

113 Wiggington Rd
Lynchburg, VA 24502
Phone (434) 385-7578

113 Wiggington Rd
Ste A
Lynchburg, VA 24502
Phone (434) 385-7578

102 Archway Ct
Lynchburg, VA 24502
Phone (434) 237-3664

Interoperability endpoints

  • Direct secure messaging: craig.petry@280.securemail.mdnavigatorclinical.com
  • Direct secure messaging: cpetry@3196.securemail.mdnavigatorclinical.com

Organizations & group practices 1

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285657213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 ARCHWAY CT",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245022889",
            "telephone_number": "434-237-3664",
            "fax_number": "434-237-3711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 ARCHWAY CT",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245022889",
            "telephone_number": "434-237-3664",
            "fax_number": "434-237-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRY",
        "first_name": "CRAIG",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101059194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS AND BLU",
            "identifier": "146316",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynchburg, VA

Sources for this page

Verify at the official NPI Registry.