NPIMap

Individual provider Active NPI

Mark G Petrizzi, MD

  • Family Medicine Physician
  • Henrico, VA
National Provider Identifier
1336152511
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101046079 Issued in VA
Practice address
3400 Haydenpark LN Ste 300
Henrico, VA 23233-7867
Phone
(804) 998-1600
Fax
(804) 998-1601
NPI assigned
Aug 15, 2006
Last updated
Feb 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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 0101046079 VA Primary

Addresses

Primary practice location

3400 Haydenpark LN Ste 300
Henrico, VA 23233-7867

Mailing address

3400 Haydenpark LN Ste 300
Henrico, VA 23233-7867
Phone (804) 998-1600

Other identifiers 1

IdentifierTypeStateIssuer
005651026MedicaidVA

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
I20101230000968 VA Practitioner - Family Practice 6901094283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Partner MD PCGroup PAC ID 8022002617, 24 clinicians

Practice addresses (Care Compare)

7001 Forest Ave
Suite 302
Richmond, VA 23230-1726
Phone (804) 282-2655

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101046079VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Partner MD PC Family Medicine CurrentSince Jan 16, 2017 Accepting new patients

Locations

13901 Coalfield Commons Pl
Midlothian, VA 23114
Phone (804) 420-1200

13901 Coalfield Commons Pl
Ste 201
Midlothian, VA 23114
Phone (804) 282-2655

3400 Haydenpark Ln
Ste 300
Richmond, VA 23233
Phone (804) 998-1600

7001 Forest Ave
Ste 302
Richmond, VA 23230
Phone (703) 288-3750

Interoperability endpoints

  • Direct secure messaging: mark.petrizzi.1@2180.direct.athenahealth.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1336152511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 HAYDENPARK LN STE 300",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232337867",
            "telephone_number": "804-998-1600",
            "fax_number": "804-998-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 HAYDENPARK LN STE 300",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232337867",
            "telephone_number": "804-998-1600",
            "fax_number": "804-998-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIZZI",
        "first_name": "MARK",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101046079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005651026",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henrico, VA

Sources for this page

Verify at the official NPI Registry.