Diane Petrovich, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA000042L Issued in PA

Practice address

75 Pineapple Street
Black Creek Health Center
Nuremberg, PA 18241-0670

Phone

(570) 384-3201

Fax

(570) 384-3454

NPI assigned

Nov 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rural Health Corporation of Northeastern Pennsylvania

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
  • NPI 1265801112
  Medicare reassignment
• Rural Health Corporation of Northeastern Pennsylvania

  • Federally Qualified Health Center (FQHC)
  • Falls, PA
  • NPI 1205938578
  NPD
• Rural Health Corporation of Northeastern Pennsylvania

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
  • NPI 1437351640
  NPD

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386723534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1084 ROUTE 315",
            "city": "WILKES-BARRE",
            "state": "PA",
            "postal_code": "187027012",
            "telephone_number": "570-825-8741",
            "fax_number": "570-825-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 PINEAPPLE STREET",
            "address_2": "BLACK CREEK HEALTH CENTER",
            "city": "NUREMBERG",
            "state": "PA",
            "postal_code": "182410670",
            "telephone_number": "570-384-3201",
            "fax_number": "570-384-3454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROVICH",
        "first_name": "DIANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA000042L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert E Astleford, D.M.D.
• Tracey Hopeck
• Patricia Lavan
• Janell Mintz
• Nuremberg Community Ambulance Association
• Rural Health Corporation of Northeastern Pennsylvania (Black Creek Health Center)
• George D Yurko, D.O.

• Physician Assistant in Nuremberg, PA
• Providers in Nuremberg, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.