Joseph Louis Petrusek, M.D., P.C.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

MD09444 Issued in OR

Practice address

710 Sunset Dr
Ste. D
La Grande, OR 97850-1200

Phone

(541) 963-8643

Fax

(541) 963-5845

NPI assigned

May 30, 2006

Last updated

Sep 24, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Joseph L. Petrusek, M.D., P.C.

  • Otolaryngology Physician
  • La Grande, OR
  • NPI 1164553285
  NPD (past) Authorized official

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1346297793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1123",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978506123",
            "telephone_number": "541-963-8643",
            "fax_number": "541-963-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 SUNSET DR",
            "address_2": "STE. D",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501200",
            "telephone_number": "541-963-8643",
            "fax_number": "541-963-5845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSEK",
        "first_name": "JOSEPH",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "M.D., P.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OR",
            "license": "MD09444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE NUMBER",
            "identifier": "041913293",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "009100000",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161026",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica Perez
• Brandi Ann Perry, RN
• Margaret Gerba Perry, N.D.
• Megan Petersen
• Bailey M Petredis
• William Alfred Pettit III, MD
• Katherine Pfister-Minogue, RN, BSN, MSN, ANP
• Karen Phelps, FNP
• Tanya Marie Phillips
• Steven K Pinther, D.O.

• Otolaryngology Physician in La Grande, OR
• Providers in La Grande, OR by specialty
• Otolaryngology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.