Active NPI
Brian Richard Petrie, D.C.
- Chiropractor
- Raynham, MA
National Provider Identifier
1447340302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1824
- Practice address
- 575 South St W
Unit 2
Raynham, MA 02767-5305 - Phone
- (508) 821-4049
- Fax
- (508) 821-2526
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1824 | MA | Primary |
Addresses
Primary practice location
575 South St W
Unit 2
Raynham, MA 02767-5305
Mailing address
575 South St W
Unit 2
Raynham, MA 02767-5305
Phone (508) 821-4049
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y36303 | Other | MA | BC/BS OF MA PROVIDER NO |
| 1601580 | Medicaid | MA | |
| 335503 | Other | MA | TUFTS OUT OF NETWORK ID |
| 401417 | Other | MA | BLUE CHIP RI ID NO |
| ZY39272 | Other | MA | BC/BS MA GROUP ID NO |
| 4981-2 | Other | MA | BC/BS RI PROVIDER NO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070822000093 | MA | Practitioner - Chiropractic | 6608968714 | Practice locations: Raynham, MA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1824 | MA | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367971200000",
"number": "1447340302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "575 SOUTH ST W",
"address_2": "UNIT 2",
"city": "RAYNHAM",
"state": "MA",
"postal_code": "027675305",
"telephone_number": "508-821-4049",
"fax_number": "508-821-2526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "575 SOUTH ST W",
"address_2": "UNIT 2",
"city": "RAYNHAM",
"state": "MA",
"postal_code": "027675305",
"telephone_number": "508-821-4049",
"fax_number": "508-821-2526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRIE",
"first_name": "BRIAN",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2013-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MA",
"license": "1824",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF MA PROVIDER NO",
"identifier": "Y36303",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1601580",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS OUT OF NETWORK ID",
"identifier": "335503",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP RI ID NO",
"identifier": "401417",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS MA GROUP ID NO",
"identifier": "ZY39272",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS RI PROVIDER NO",
"identifier": "4981-2",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raynham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.