Active NPI
Kristina M Petraitis
- Case Manager/Care Coordinator
- Westerville, OH
National Provider Identifier
1487157996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- COBA.00616
- Practice address
- 195 W Schrock Rd
Westerville, OH 43081-2890 - Phone
- (614) 355-7570
- Fax
- (614) 355-7533
- NPI assigned
- Mar 10, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | OH | ||
| Case Manager/Care Coordinator | 171M00000X | COBA.00616 | OH | Primary |
Addresses
Primary practice location
195 W Schrock Rd
Westerville, OH 43081-2890
Mailing address
PO Box 78000
Detroit, MI 48278-1625
Phone (614) 355-8004
Other practice location 1
2114 Noble Rd
Cleveland, OH 44112-1725
Phone (216) 268-2400
Other practice location 2
2540 Billingsley Rd
Columbus, OH 43235-1990
Phone (614) 470-6473
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1473276 | Medicaid | OH |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COBA.00616 | OH | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571788800000",
"number": "1487157996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 78000",
"city": "DETROIT",
"state": "MI",
"postal_code": "482781625",
"telephone_number": "614-355-8004",
"fax_number": "614-355-2220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "195 W SCHROCK RD",
"city": "WESTERVILLE",
"state": "OH",
"postal_code": "430812890",
"telephone_number": "614-355-7570",
"fax_number": "614-355-7533"
}
],
"practiceLocations": [
{
"address_1": "2114 Noble Rd",
"address_purpose": "LOCATION",
"city": "Cleveland",
"state": "OH",
"postal_code": "441121725",
"country_code": "US",
"telephone_number": "216-268-2400",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2540 Billingsley Rd",
"address_purpose": "LOCATION",
"city": "Columbus",
"state": "OH",
"postal_code": "432351990",
"country_code": "US",
"telephone_number": "614-470-6473",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETRAITIS",
"first_name": "KRISTINA",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-10",
"last_updated": "2019-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "OH",
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OH",
"license": "COBA.00616",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1473276",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Westerville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.