Michael Edward Petravick, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

125.072611 Issued in IL

Practice address

1650 W Harrison St Ste 466
Chicago, IL 60612-3800

Phone

(309) 868-4988

NPI assigned

Jun 26, 2018

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

Medicare fee-for-service enrollment

Enrolled in IL

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

Anesthesiology

Education

Rush Medical College of Rush University, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Associated Anesthesiologists SCGroup PAC ID 6305744129, 150 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

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.

• Associated Anesthesiologists, S.C.

  • Anesthesiology Physician
  • Peoria, IL
  • NPI 1558306480
  Medicare reassignment Care Compare group NPD
• Associated Anesthesiologists, SC

  • Anesthesiology Physician
  • Peoria, IL
  • NPI 1023612082
  NPD

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1649765264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 W DEMING PL APT 516",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606146412",
            "telephone_number": "309-868-4988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 W HARRISON ST STE 466",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123800",
            "telephone_number": "309-868-4988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRAVICK",
        "first_name": "MICHAEL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-26",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "125.072611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Petr, PA-C
• Leah Kristina Petrak, PA-C
• Stephen Petrak, D.C
• Alexandra Petrakos, MD
• Paige Avery Petrando, CCC-SLP
• Louis C Petrelli, PT, DPT
• Jessica Petreski, PA-C
• Adam M Petrich, MD
• Gail S Petrich, PSY.D.
• Petrie Storer & Associates DDS PC

• Anesthesiology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; 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.