Active NPI
Timothy Petrosky, PA
- Physician Assistant
- Novi, MI
National Provider Identifier
1609844208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601003397
- Practice address
- 26850 Providence Pkwy
Suite 260
Novi, MI 48374 - Phone
- (248) 735-8272
- Fax
- (248) 735-7276
- NPI assigned
- Mar 9, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601003397 | MI | Primary |
Addresses
Primary practice location
26850 Providence Pkwy
Suite 260
Novi, MI 48374
Mailing address
61 Commerce Ave SW
Grand Rapids, MI 49503
Phone (616) 940-0660
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
39000 7 Mile Rd
Livonia, MI 48152-1006
Phone (734) 259-6015
6200 N Haggerty Rd
Canton, MI 48187-3605
Hospital & facility affiliations
- Trinity Health Ann Arbor Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
-
- Pain Medicine Physician
- Canton, MI
- NPI 1437478716
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Ypsilanti, MI
- NPI 1780658443
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240272000000",
"number": "1609844208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 COMMERCE AVE SW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49503",
"telephone_number": "616-940-0660",
"fax_number": "616-940-1965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26850 PROVIDENCE PKWY",
"address_2": "SUITE 260",
"city": "NOVI",
"state": "MI",
"postal_code": "48374",
"telephone_number": "248-735-8272",
"fax_number": "248-735-7276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROSKY",
"first_name": "TIMOTHY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-09",
"last_updated": "2009-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601003397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2009; 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.