Individual provider Active NPI

Peter Allan Petrukitas, ARNP

  • Adult Health Nurse Practitioner
  • Tacoma, WA
National Provider Identifier
1396175220
Registry record updated May 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
AP60396780 Issued in WA
Practice address
1901 S Cedar St Ste 301
Tacoma, WA 98405-2302
Phone
(253) 572-7320
NPI assigned
Nov 13, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X AP60396780 WA Primary

Addresses

Primary practice location

1901 S Cedar St Ste 301
Tacoma, WA 98405-2302

Mailing address

1901 S Cedar St Ste 301
Tacoma, WA 98405-2302
Phone (253) 572-7320

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20140226000340 WA Practitioner - Nurse Practitioner 4688804339 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
  • Capital Medical Center Hospital, Olympia, WA, CCN 500139
  • Summit Pacific Medical Center Hospital, Elma, WA, CCN 501304
  • Mason General Hospital & Family of Clinics Hospital, Shelton, WA, CCN 501336

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince May 1, 2016 Accepting new patients
Multicare Health System CurrentSince May 1, 2016 Accepting new patients
Multicare Health System Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

17700 SE 272nd St
Kent, WA 98042
Phone (253) 372-6500

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

1901 S Cedar St
Ste 301
Tacoma, WA 98405
Phone (253) 396-4806

Interoperability endpoints

  • Direct secure messaging: ppetrukitas123984@direct.multicare.org

Organizations & group practices 4

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.

Hospital & facility affiliations 8

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": "1384300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462492800000",
    "number": "1396175220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 S CEDAR ST STE 301",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984052302",
            "telephone_number": "253-572-7320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S CEDAR ST STE 301",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984052302",
            "telephone_number": "253-572-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUKITAS",
        "first_name": "PETER",
        "middle_name": "ALLAN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-13",
        "last_updated": "2016-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WA",
            "license": "AP60396780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.