Lisa F Petraccione, RPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004441 Issued in NY

Practice address

3732 Carman Rd
Schenectady, NY 12303-5422

Phone

(518) 356-4132

Fax

(518) 355-3996

NPI assigned

Aug 31, 2006

Sex

Female

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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Community Care Physicians, PC

  • Family Medicine Physician
  • Albany, NY
  • NPI 1811946775

  Physician Assistant

  NPD (past)
• Community Care Physicians, PLLC

  dba Community Care Family Practice Ballston Spa

  • Family Medicine Physician
  • Ballston Spa, NY
  • NPI 1548541246
  NPD (past)
• Community Care Physicians, PLLC

  • Internal Medicine Physician
  • Latham, NY
  • NPI 1922048370
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1639280332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3732 CARMAN RD",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123035422",
            "telephone_number": "518-356-4132",
            "fax_number": "518-355-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRACCIONE",
        "first_name": "LISA",
        "middle_name": "F",
        "name_prefix": "Ms.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "004441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSNENY",
            "identifier": "000498833001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "070507000057",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02215098",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP HEALTHCARE",
            "identifier": "356367",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey Peruzzi, OT
• Robert James Peters, LCSW
• Charles Craig Peterson, M.D.
• Haley Peterson
• Julie Anne Peterson, CMHN
• John M Petrillo, D.O.
• Joseph A Petrosino, P.A.
• Lisa Petroski, RD
• Wyndi Lois Pettibone, MS CCC-SLP
• Peter I Pfaffenbach, DDS

• Physician Assistant in Schenectady, NY
• Providers in Schenectady, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.