NPIMap

Individual provider Active NPI

James Joseph Petillo, M.D.

  • Emergency Medicine Physician
  • Ft Lauderdale, FL
National Provider Identifier
1376591917
Registry record updated Aug 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME40178 Issued in FL
Practice address
3325 Griffin Road
# 257
Ft Lauderdale, FL 33312-5500
Phone
(954) 404-0664
Fax
(954) 964-4418
NPI assigned
May 5, 2006
Reactivated
Aug 11, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X ME40178 FL
Emergency Medicine Physician 207P00000X ME40178 FL Primary

Addresses

Primary practice location

3325 Griffin Road
# 257
Ft Lauderdale, FL 33312-5500

Mailing address

3325 Griffin Road
# 257
Ft Lauderdale, FL 33312-5500
Phone (954) 404-0664

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

State licenses

LicenseStateTypeSpecialty
ME40178FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
B.L. X-Ray Corp. Past Accepting new patients
O & Y Medical Corp Inc. Past Accepting new patients
Cajina Anesthesia, PA Past Accepting new patients
Adcos 75 Medical Group, Inc. Past Accepting new patients
Biscayne Medical Group Past Accepting new patients
Hallandale Rehabilitation Inc Legal Medicine Past Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251676800000",
    "number": "1376591917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 GRIFFIN ROAD",
            "address_2": "# 257",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333125500",
            "telephone_number": "954-404-0664",
            "fax_number": "954-964-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 GRIFFIN ROAD",
            "address_2": "# 257",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333125500",
            "telephone_number": "954-404-0664",
            "fax_number": "954-964-4418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETILLO",
        "first_name": "JAMES",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2009-08-31",
        "deactivation_date": "2009-02-09",
        "reactivation_date": "2009-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "FL",
            "license": "ME40178",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME40178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; 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.