Active NPI
David B Petruska, MD
- Emergency Medicine Physician
- Honolulu, HI
National Provider Identifier
1558417352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- MD-7349
- Practice address
- 3288 Moanalua Rd
Honolulu, HI 96819-1469 - Phone
- (808) 432-0000
- NPI assigned
- Jan 25, 2007
- 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MD-7349 | HI | Primary |
Addresses
Primary practice location
3288 Moanalua Rd
Honolulu, HI 96819-1469
Mailing address
3288 Moanalua Rd
Honolulu, HI 96819-1469
Phone (808) 432-0000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000082602 | Other | HI | HMSA BILLING NUMBER |
| 062281-01 | Medicaid | HI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-7349 | HI | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192665600000",
"number": "1558417352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3288 MOANALUA RD",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968191469",
"telephone_number": "808-432-0000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3288 MOANALUA RD",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968191469",
"telephone_number": "808-432-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUSKA",
"first_name": "DAVID",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-25",
"last_updated": "2007-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "HI",
"license": "MD-7349",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA BILLING NUMBER",
"identifier": "0000082602",
"state": "HI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "062281-01",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Honolulu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.