Individual provider Active NPI

Guy J. Petruzzelli, MD, PHD

  • Otolaryngology Physician
  • Savannah, GA
National Provider Identifier
1528045481
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
067957 Issued in GA
Practice address
4700 Waters Ave
Savannah, GA 31404
Phone
(912) 350-2299
Fax
(912) 350-2298
NPI assigned
Dec 30, 2005
Last updated
Aug 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 067957 GA Primary

Addresses

Primary practice location

4700 Waters Ave
Savannah, GA 31404

Mailing address

4700 Waters Ave
Savannah, GA 31404-6220
Phone (912) 350-2299

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050813000130 IL Practitioner - Otolaryngology 9234169814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision25
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
067957GAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Mar 30, 2020 Accepting new patients
Cardinal Medical Group, LTD. Past Accepting new patients

Locations

1310 N Missouri Ave
Peoria, IL 61603
Phone (309) 308-3800

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

8600 State Route 91
Ste 300
Peoria, IL 61615
Phone (309) 691-6616

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533600000000",
    "number": "1528045481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 WATERS AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314046220",
            "telephone_number": "912-350-2299",
            "fax_number": "912-350-2298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 WATERS AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31404",
            "telephone_number": "912-350-2299",
            "fax_number": "912-350-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUZZELLI",
        "first_name": "GUY",
        "middle_name": "J.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2018-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "067957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.