Gregory D. Petrilla, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DS039264 Issued in PA

Practice address

590 Indian Springs Rd
Indiana, PA 15701-3600

Phone

(724) 465-6100

Fax

(724) 465-6110

NPI assigned

Jul 23, 2012

Last updated

Aug 16, 2019By the provider in NPPES

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 4

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gregorypetrilla@primaryhn.medalliesdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Primary Health Network

  • Federally Qualified Health Center (FQHC)
  • Sharon, PA
  • NPI 1417932609
  Medicare reassignment NPD
• Primary Health Network

  • Federally Qualified Health Center (FQHC)
  • Emlenton, PA
  • NPI 1750181038
  NPD

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

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1679828081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SHENANGO AVE",
            "city": "SHARON",
            "state": "PA",
            "postal_code": "161461503",
            "telephone_number": "724-465-6100",
            "fax_number": "724-465-6110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 INDIAN SPRINGS RD",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013600",
            "telephone_number": "724-465-6100",
            "fax_number": "724-465-6110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Pinnacle Dr",
            "address_purpose": "LOCATION",
            "city": "Clarion",
            "state": "PA",
            "postal_code": "162143800",
            "country_code": "US",
            "telephone_number": "814-223-9906",
            "fax_number": "814-223-9912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRILLA",
        "first_name": "GREGORY",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-23",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102747929",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027479290003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027479290001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027479290002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Carol Peoples, CRNP
• Brittany Nicole Persing
• Brian Garry Petras, DMD
• Michael Petras
• Paul J. Petras, O.D.
• Olivia Petrosky, OTR/L
• Stephen Petrosky, D.P.T.
• Dana Nicole Pfau, DC
• Yeshwant Gopal Phadke, M.D.
• Phoenix Rehabilitation and Health Services, Inc.

• Dentist in Indiana, PA
• Providers in Indiana, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.