Priscilla Louise Petrash, P.A.-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA08202B Issued in TX

Practice address

17110 Dallas Pkwy Ste 100
Dallas, TX 75248-1167

Phone

(972) 380-7000

Fax

(972) 380-9266

NPI assigned

Oct 25, 2013

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/AFFIBD
• FHIR API: https://api.platform.athenahealth.com/14693/brand/1/csg/1/fhir/r4

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.

• Old Town Family Practice PA

  • Family Medicine Physician
  • Coppell, TX
  • NPI 1487757571
  Medicare reassignment
• Minuteclinic Diagnostic of North Carolina PC

  • Family Nurse Practitioner
  • Raleigh, NC
  • NPI 1699748608
  Medicare reassignment
• Bent Tree Family Physician, PA

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1124180120
  NPD (past)
• Wake Family Medicine PC

  • General Practice Physician
  • Cary, NC
  • NPI 1215162466
  NPD (past)

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

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1427486646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17110 DALLAS PKWY STE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481167",
            "telephone_number": "972-380-7000",
            "fax_number": "972-380-9266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17110 DALLAS PKWY STE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481167",
            "telephone_number": "972-380-7000",
            "fax_number": "972-380-9266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRASH",
        "first_name": "PRISCILLA",
        "middle_name": "LOUISE",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-25",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "PA08202B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL BOARD",
            "identifier": "PA08202",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA MEDICAL BOARD",
            "identifier": "0010-04262",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Petka
• Radina G. Petkova, DDS
• Brandon Lloyd Petkovich, CRNA
• Christina Allison Petkovich, CRNA
• Jan Petrasek, M.D., PH.D.
• Rodica Elena Petrea, M.D.
• Tyler Robert Petree, DO
• Laura Petrey, M.D.
• Jan Karel Petric, CO
• Heather Socha Petrie, RN, CPNP-PC

• Family Medicine Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; 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.