Active NPI
Anthony Petracca Jr., M.D.
- Family Medicine Physician
- Glens Falls, NY
National Provider Identifier
1487636874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 167575
- Practice address
- 3 Irongate Center
Glens Falls, NY 12801-3471 - Phone
- (518) 793-4409
- Fax
- (518) 793-5886
- NPI assigned
- Nov 19, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 167575 | NY | Primary |
Addresses
Primary practice location
3 Irongate Center
Glens Falls, NY 12801-3471
Mailing address
3 Irongate Center
Glens Falls, NY 12801-3471
Phone (518) 793-4409
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000401245001 | Other | NY | BLUE SHIELD NENY |
| CD1981 | Other | NY | RAILROAD MEDICARE GROUP # |
| 10470641 | Other | NY | CAQH |
| 5500215 | Other | NY | AETNA |
| 01346818 | Medicaid | NY | |
| 10002650 | Other | NY | CDPHP |
| 56K521 | Other | NY | BLUE CROSS BLUE SHIELD |
| 000000056116 | Other | NY | GHI-HMO |
| 00020592301 | Other | NY | UNIVERA |
| 021200700350 | Other | NY | FIDELIS |
| 08219 | Other | NY | MVP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- State University of Ny Upstate Medical University, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3 Irongate Ctr
Glens Falls, NY 12801-3471
Phone (518) 793-4409
Hospital & facility affiliations
- Eddy Visiting Nurse & Rehab Association
- Vna Home Health
- Warren Co HLTH SVS Chha
- High Peaks Hospice and Palliative Care, Inc
- Glens Falls Hospital
- Saratoga Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 17 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 15 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 167575 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Irongate Family Practice Associates PLLC | Family Medicine | Current | Accepting new patients |
Locations
3 Irongate Ctr
Glens Falls, NY 12801
Phone (518) 793-4409
Interoperability endpoints
- apetracca@irongatefamilypractice.medentdirect.com
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Glens Falls, NY
- NPI 1851326326
Hospital & facility affiliations 24
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Glens Falls, NY
- NPI 1871606764
-
- Community Based Hospice Care Agency
- Hudson Falls, NY
- NPI 1750442513
-
- Home Health Agency
- Troy, NY
- NPI 1114967924
-
- Endocrinology, Diabetes & Metabolism Physician
- Gansevoort, NY
- NPI 1033371166
Hospital
-
- General Acute Care Hospital
- Saratoga Springs, NY
- NPI 1073569331
-
- General Acute Care Hospital
- Saratoga Springs, NY
- NPI 1093078560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202860800000",
"number": "1487636874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 IRONGATE CENTER",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128013471",
"telephone_number": "518-793-4409",
"fax_number": "518-793-5886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 IRONGATE CENTER",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128013471",
"telephone_number": "518-793-4409",
"fax_number": "518-793-5886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRACCA",
"first_name": "ANTHONY",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-19",
"last_updated": "2008-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "167575",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD NENY",
"identifier": "000401245001",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GROUP #",
"identifier": "CD1981",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10470641",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5500215",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01346818",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDPHP",
"identifier": "10002650",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "56K521",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI-HMO",
"identifier": "000000056116",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERA",
"identifier": "00020592301",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS",
"identifier": "021200700350",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "08219",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glens Falls, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.