Individual provider Active NPI

Ryan Petrowsky, ATC, PA-C

  • Medical Physician Assistant
  • New Haven, CT
National Provider Identifier
1497862205
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2884 Issued in CT
Practice address
1450 Chapel St
New Haven, CT 06511-4405
Phone
(203) 789-3200
NPI assigned
Aug 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 000210 CT
Physician Assistant 363A00000X CT
Medical Physician Assistant 363AM0700X 2884 CT Primary

Addresses

Primary practice location

1450 Chapel St
New Haven, CT 06511-4405

Mailing address

300 George St
FL 6
New Haven, CT 06511-6624
Phone (203) 785-6610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20150319001030 CT Practitioner - Physician Assistant 6709103310 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.36 of 100Reported as group
Quality
77.36
Promoting interoperability
100
Improvement activities
40
Cost
74.27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
000210CTMDPodiatrist
2884CTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. CurrentSince Apr 3, 2013 Accepting new patients
Yale University CurrentSince Jan 14, 2019 Accepting new patients
Yale University CurrentSince Jan 14, 2019 Accepting new patients
Mill Hill Medical Consultants Inc CurrentSince Apr 3, 2013 Accepting new patients

Locations

300 George St
Fl 6
New Haven, CT 06511
Phone (203) 785-6610

55 Lock St
New Haven, CT 06511
Phone (203) 432-0076

1450 Chapel St
New Haven, CT 06511
Phone (203) 789-3151

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

Interoperability endpoints

  • Direct secure messaging: rpetrowsky105289@direct.ynhh.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.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1497862205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 GEORGE ST",
            "address_2": "FL 6",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065116624",
            "telephone_number": "203-785-6610",
            "fax_number": "203-785-6414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 CHAPEL ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065114405",
            "telephone_number": "203-789-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROWSKY",
        "first_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "ATC, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CT",
            "license": "000210",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "2884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.