NPIMap

Individual provider Active NPI

Joseph Petrolla, PA-C

  • Physician Assistant
  • Poland, OH
National Provider Identifier
1568280345
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.009061RX Issued in OH
Practice address
6615 Clingan Rd
Poland, OH 44514-2196
Phone
(330) 757-7888
NPI assigned
Sep 30, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.009061RX OH Primary

Addresses

Primary practice location

6615 Clingan Rd
Poland, OH 44514-2196

Mailing address

6615 Clingan Rd
Poland, OH 44514-2196
Phone (330) 757-7888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20250521002618 OH Practitioner - Physician Assistant 0042740672 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ohio North East Health Systems Inc 34 clinicians

Practice addresses (Care Compare)

1977 Niles Rd SE
Warren, OH 44484-5118
Phone (330) 393-6446

716 Tod Ave SW
Warren, OH 44485-3608
Phone (330) 373-0222

726 Wick Ave
Youngstown, OH 44505-2827
Phone 330747955177182

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.009061RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ohio North East Health Systems Inc CurrentSince Oct 6, 2025 Accepting new patients
Ohio North East Health Systems, Inc. CurrentSince Oct 6, 2025 Accepting new patients
Ohio North East Health Systems, Inc. Current Accepting new patients
Ohio North East Health Systems, Inc Past Accepting new patients
Pathology Laboratories, Inc. Past Accepting new patients

Locations

716 Tod Ave SW
Warren, OH 44485
Phone (330) 373-0222

1977 Niles Rd SE
Warren, OH 44484
Phone (330) 372-5800

726 Wick Ave
Youngstown, OH 44505
Phone (330) 747-2330

Interoperability endpoints

  • Direct secure messaging: joseph.petrolla.p1@direct.oho.nextgenshare.com

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1568280345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN RD",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445142196",
            "telephone_number": "330-757-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN RD",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445142196",
            "telephone_number": "330-757-7888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROLLA",
        "first_name": "JOSEPH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-30",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.009061RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poland, OH

Sources for this page

Verify at the official NPI Registry.