NPIMap

Individual provider Active NPI

John J Petronovich, M.D.

  • Surgery Physician
  • Wausau, WI
National Provider Identifier
1548600190
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
62902-02 Issued in WI
Practice address
2727 Plaza Dr
Wausau, WI 54401-4129
Phone
(262) 443-0948
NPI assigned
Jun 27, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 62902-02 WI Primary

Addresses

Primary practice location

2727 Plaza Dr
Wausau, WI 54401-4129

Mailing address

1415 N Broadway Ave
Marshfield, WI 54449-1321
Phone (262) 443-0948

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@marshfieldclinichealthsystem.cernerdirect.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180827001889 WI Practitioner - General Surgery 3577785658 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Medical College of Wisconsin, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCHS Hospitals IncGroup PAC ID 5698071173, 1,195 clinicians

Practice addresses (Care Compare)

1000 N Oak Ave
Marshfield, WI 54449-5703
Phone (715) 387-5511

2727 Plaza Dr
Wausau, WI 54401-4129
Phone (715) 847-3000

3400 Ministry Pkwy
Weston, WI 54476-5220
Phone (715) 393-1000

4100 State Hwy 66
Stevens Point, WI 54482-8410
Phone (715) 997-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.58 of 100Reported as group
Quality
55.5
Promoting interoperability
100
Improvement activities
40
Cost
71.46

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy35
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux54
Melanoma (skin cancer) excision1-10
Removal of tissue29
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62902-02WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc CurrentSince Jan 13, 2019 Accepting new patients
Marshfield Clinic Inc Multi-Specialty CurrentSince Aug 6, 2018 Accepting new patients
MCHS Hospitals Inc Multi-Specialty Current Accepting new patients
MCHS Hospitals Inc Multi-Specialty CurrentSince Jan 13, 2019 Accepting new patients
Memorial Hospital Inc Past Accepting new patients

Locations

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850

611 N Saint Joseph Ave
Marshfield, WI 54449
Phone (715) 387-1713

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

1205 O Day St
Merrill, WI 54452
Phone (715) 539-0101

9576 State Highway 70
Minocqua, WI 54548
Phone (715) 358-1000

4100 State Highway 66
Stevens Point, WI 54482
Phone (715) 343-7700

2727 Plaza Dr
Wausau, WI 54401
Phone (715) 847-3000

3400 Ministry Pkwy
Weston, WI 54476
Phone (715) 393-1000

Interoperability endpoints

  • Direct secure messaging: john.petronovich@marshfieldclinichealthsystem.cernerdirect.com
  • Direct secure messaging: him@marshfieldclinichealthsystem.cernerdirect.com

Organizations & group practices 5

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1548600190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 N BROADWAY AVE",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544491321",
            "telephone_number": "262-443-0948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 PLAZA DR",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014129",
            "telephone_number": "262-443-0948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRONOVICH",
        "first_name": "JOHN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-27",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "WI",
            "license": "62902-02",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "address_1": "2727 Plaza Dr",
            "city": "Wausau",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544014129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.