NPIMap

Individual provider Active NPI

James A Petterchak, MD

  • Forensic Pathology Physician
  • St. Louis, MO
National Provider Identifier
1598832032
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Forensic Pathology PhysicianTaxonomy code 207ZF0201X
License
036-101883 Issued in IL
Practice address
3015 N. Ballas
Dept of Pathology
St. Louis, MO 63131
Phone
(314) 996-5551
Fax
(314) 996-5551
NPI assigned
Nov 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Forensic Pathology Physician 207ZF0201X 036-101883 IL Primary
Anatomic Pathology Physician 207ZP0101X 036-101883 IL
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X 036-101883 IL

Addresses

Primary practice location

3015 N. Ballas
Dept of Pathology
St. Louis, MO 63131

Mailing address

3015 N. Ballas
Dept of Pathology
St. Louis, MO 63131
Phone (314) 996-5551

Other identifiers 1

IdentifierTypeStateIssuer
1598832032MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20080825000456 MO Practitioner - Pathology 9830291061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Saint Louis University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Parkway Pathology Group IncGroup PAC ID 5496728818, 9 clinicians

Practice addresses (Care Compare)

10 Hospital Dr
Saint Peters, MO 63376-1659
Phone (636) 916-9650

3015 N Ballas Rd
Saint Louis, MO 63131-2329
Phone (314) 996-5000

Hospital & facility affiliations

  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • Barnes-Jewish St Peters Hospital Hospital, Saint Peters, MO, CCN 260191
  • Progress West Hospital Hospital, Ofallon, MO, CCN 260219
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Missouri Baptist Sullivan Hospital Hospital, Sullivan, MO, CCN 261337

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-101883ILMDAnatomic Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parkway Pathology Group, Inc. Forensic Pathology CurrentSince Aug 15, 2008 Accepting new patients
Missouri Baptist Medical Center Current Accepting new patients
Parkway Pathology Group Past Accepting new patients

Locations

3015 N Ballas Rd
Saint Louis, MO 63131
Phone (314) 996-5330

751 Sappington Bridge Rd
Sullivan, MO 63080
Phone (573) 468-1343

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1598832032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 N. BALLAS",
            "address_2": "DEPT OF PATHOLOGY",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63131",
            "telephone_number": "314-996-5551",
            "fax_number": "314-996-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 N. BALLAS",
            "address_2": "DEPT OF PATHOLOGY",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63131",
            "telephone_number": "314-996-5551",
            "fax_number": "314-996-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERCHAK",
        "first_name": "JAMES",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZF0201X",
            "taxonomy_group": "",
            "desc": "Pathology, Forensic Pathology",
            "state": "IL",
            "license": "036-101883",
            "primary": true
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "IL",
            "license": "036-101883",
            "primary": false
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "IL",
            "license": "036-101883",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598832032",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St. Louis, MO

Sources for this page

Verify at the official NPI Registry.