Individual provider Active NPI

Gail D Petteruti, PAC

  • Surgical Physician Assistant
  • Seattle, WA
National Provider Identifier
1295768356
Registry record updated Oct 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA10004209 Issued in WA
Practice address
2409 N 45TH St
Seattle, WA 98103-6907
Phone
(206) 633-8100
Fax
(206) 633-6107
NPI assigned
Jul 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA10004209 WA Primary

Addresses

Primary practice location

2409 N 45TH St
Seattle, WA 98103-6907

Mailing address

805 Madison St
Suite 901
Seattle, WA 98104-1172
Phone (206) 264-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050713000569 WA Practitioner - Physician Assistant 5294761011 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

2409 N 45TH St
Seattle, WA 98103-6907
Phone (425) 673-3900

Hospital & facility affiliations

  • Swedish Medical Center Hospital, Seattle, WA, CCN 500027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc., P.S. Surgical CurrentSince Jul 1, 2002 Accepting new patients
Proliance Surgeons Inc., P.S. Surgical Current Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Jul 1, 2002 Accepting new patients

Locations

2409 N 45th St
Seattle, WA 98103
Phone (206) 633-8100

1801 NW Market St
Ste 403
Seattle, WA 98107
Phone (206) 297-5100

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Interoperability endpoints

  • Direct secure messaging: gail.petteruti.p2@direct.proliance.nextgenshare.com

Organizations & group practices 4

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 1

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": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318204800000",
    "number": "1295768356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST",
            "address_2": "SUITE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-264-8100",
            "fax_number": "206-264-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2409 N 45TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981036907",
            "telephone_number": "206-633-8100",
            "fax_number": "206-633-6107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERUTI",
        "first_name": "GAIL",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2011-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10004209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.