Robert John Petrella, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

75111 Issued in MA

Practice address

1153 Centre St
Faulkner Hospital Emergency Department
Boston, MA 02130-3446

Phone

(617) 983-7700

NPI assigned

Jun 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MA, RI2 enrollments

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 2

Specialty

Emergency MedicineAlso: Internal Medicine

Education

Icahn School of Medicine at Mount Sinai, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Care Services of New England PCGroup PAC ID 9739487562, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Our Lady of Fatima Hospital Hospital, North Providence, RI, CCN 410005

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.

• Emergency Care Services of New England PC

  • Emergency Medicine Physician
  • North Providence, RI
  • NPI 1639537335
  Medicare reassignment Care Compare group NPD
• Steward Emergency Physicians, Inc

  • Emergency Medicine Physician
  • Ayer, MA
  • NPI 1780971275
  Medicare reassignment
• Caritas Medical Group, Inc.

  • Specialist
  • Brighton, MA
  • NPI 1174513204
  NPD (past)
• Melrose Wakefield Emergency Physicians, Inc.

  • Emergency Medicine Physician
  • Melrose, MA
  • NPI 1790730539
  NPD (past)
• Steward Medical Group, Inc.

  • Specialist
  • Brighton, MA
  • NPI 1801109947
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prospect Chartercare Sjhsri, LLC

  • General Acute Care Hospital
  • North Providence, RI
  • NPI 1871918870
  Care Compare affiliation

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214870400000",
    "number": "1689619835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SANBORN AVE",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021323834",
            "telephone_number": "617-323-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1153 CENTRE ST",
            "address_2": "FAULKNER HOSPITAL EMERGENCY DEPARTMENT",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021303446",
            "telephone_number": "617-983-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRELLA",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2008-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "75111",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "75111",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3110613",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "J13837",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "075111",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexa Nicola Petkewich, PHYSICIAN ASSISTANT
• Maria Carolina Petracca
• Milena Petranovic, M.D.
• Denise Petrella, N.P.
• Jocelyn N Petrella, MA
• Camille Petri, M.D.
• Aldis Haralds Petriceks
• Randi A Petricone, NP
• Athena Kantartzis Petrides, PH.D.
• Rachel Petrie, AUD

• Emergency Medicine Physician in Boston, MA
• Providers in Boston, MA by specialty
• Emergency Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; 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.