Active NPI
Pamela Joan Petrocy, MD
- Orthopaedic Surgery Physician
- Caribou, ME
National Provider Identifier
1366496887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- MD21228
- Practice address
- 163 Van Buren Rd
Caribou, ME 04736-3567 - Phone
- (207) 493-5791
- Fax
- (207) 498-1326
- NPI assigned
- May 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | MD21228 | ME | Primary |
Addresses
Primary practice location
163 Van Buren Rd
Caribou, ME 04736-3567
Mailing address
163 Van Buren Rd
Caribou, ME 04736-3567
Phone (207) 493-5791
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08330226 | Medicaid | MS | |
| 1423777 | Medicaid | LA | |
| 2574254 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orleans Orthopaedic Associates, LLC | Orthopaedic Surgery | Past | Accepting new patients |
| Freiberg Orthopaedics & Sports Medicine | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Sports Medicine (Orthopaedic Surgery) Physician
- Cincinnati, OH
- NPI 1861450017
-
- Orthopaedic Surgery Physician
- New Orleans, LA
- NPI 1528177532
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467158400000",
"number": "1366496887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 VAN BUREN RD",
"city": "CARIBOU",
"state": "ME",
"postal_code": "047363567",
"telephone_number": "207-493-5791",
"fax_number": "207-498-1326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 VAN BUREN RD",
"city": "CARIBOU",
"state": "ME",
"postal_code": "047363567",
"telephone_number": "207-493-5791",
"fax_number": "207-498-1326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROCY",
"first_name": "PAMELA",
"middle_name": "JOAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-20",
"last_updated": "2016-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "ME",
"license": "MD21228",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08330226",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1423777",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2574254",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Caribou, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.