Jason Alexander Petrofski, MD

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

059311 Issued in GA

Practice address

1505 Northside Blvd
Suite 1900
Cumming, GA 30041-7623

Phone

(678) 341-3764

Fax

(678) 341-3769

NPI assigned

Jan 30, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Colorectal Surgery (Proctology)

Education

Johns Hopkins University School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Surgical Professional Services LLCGroup PAC ID 8628253424, 367 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tugaloo Home Health Agency, an Amedisy Company Home health agency, Gainesville, GA, CCN 117305
• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005
• Northside Hospital Hospital, Atlanta, GA, CCN 110161

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  Medicare reassignment Care Compare group NPD

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

• Amedisys Georgia, L.L.C.

  dba Tugaloo Home Health Agency, an Amedisys Company

  • Home Health Agency
  • Gainesville, GA
  • NPI 1912955667
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital Forsyth

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597017600000",
    "number": "1568508893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 NORTHSIDE BLVD",
            "address_2": "SUITE 1900",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417623",
            "telephone_number": "678-341-3764",
            "fax_number": "678-341-3769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 NORTHSIDE BLVD",
            "address_2": "SUITE 1900",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417623",
            "telephone_number": "678-341-3764",
            "fax_number": "678-341-3769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROFSKI",
        "first_name": "JASON",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "GA",
            "license": "059311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "236918506A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "236918506E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "236918506D",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jasonpetrofski@acrssj.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "1505 Northside Blvd",
            "address_2": "Suite 1900",
            "city": "Cumming",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300417623",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Barbara Joyce Peters, LPC
• Heather Peters, CPNP
• Stephanie Lynn Peterson-Eichhorn, M.A., CCC-SLP
• Jessica Lynn Peterson
• Isabel Petree
• Kristen Petros, DPT
• George S Petryk, DC,DACNB,FACFN,FABES
• James Michael Petway, M.D., F.C.C.P.
• Brittany Petz
• Allison B Phad, CCC-SLP

• Colon & Rectal Surgery Physician in Cumming, GA
• Providers in Cumming, GA by specialty
• Colon & Rectal Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.