Brian Dion Petrovich, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2004017583 Issued in MO

Practice address

1186 E 4600 S
Ogden, UT 84403-4332

Phone

(801) 505-6545

NPI assigned

Jan 27, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Ogden Psychological Services LLC

  • Clinical Psychologist
  • Ogden, UT
  • NPI 1417506270
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1336110568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1186 E 4600 S",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844034332",
            "telephone_number": "801-505-6545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1186 E 4600 S",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844034332",
            "telephone_number": "801-505-6545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Wilford Hall Loop Bldg 4554",
            "address_purpose": "LOCATION",
            "city": "Jbsa Lackland",
            "state": "TX",
            "postal_code": "782365638",
            "country_code": "US",
            "telephone_number": "210-292-6885",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7321 Balmer St",
            "address_purpose": "LOCATION",
            "city": "Hill AFB",
            "state": "UT",
            "postal_code": "840565012",
            "country_code": "US",
            "telephone_number": "719-777-7909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETROVICH",
        "first_name": "BRIAN",
        "middle_name": "DION",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2004017583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "494703309",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Nicole Peterson, FNP-C
• Rex J. Peterson, D.D.S.
• Scott David Peterson, O.D.
• Nicole Peto, RN
• Whitney Petri, OTR/L
• Madelyn Petty
• Paige Phalen
• Joshua Raphael Phelps, FNP, D.C.
• Nathan Phelps, MD
• Philip B. Johnson, M.S., P.C.

• Psychologist in Ogden, UT
• Providers in Ogden, UT by specialty
• Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.