NPIMap

Individual provider Active NPI

Russell Sean Petrie, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Newport Beach, CA
National Provider Identifier
1730119074
Registry record updated Feb 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
G85402 Issued in CA
Practice address
22 Corporate Plaza Dr
Newport Beach, CA 92660-7901
Phone
(949) 722-7038
Fax
(949) 630-4935
NPI assigned
Jul 3, 2006
Last updated
Feb 17, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X G85402 CA Primary

Addresses

Primary practice location

22 Corporate Plaza Dr
Newport Beach, CA 92660-7901

Mailing address

22 Corporate Plaza Dr
Newport Beach, CA 92660-7901
Phone (949) 722-7038

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120302000448 CA Practitioner - Orthopedic Surgery 8123021730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Mayo Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

22 Corporate Plaza Dr
Newport Beach, CA 92660-7985
Phone (949) 722-7038

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.23 of 100Reported as group
Quality
99.26
Improvement activities
40
Cost
75.46

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)15
Upper limb (arm) arthroscopy (minimally invasive joint repair)32
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
85402CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Institute of Newport Beach Limited Partnership CurrentSince Jan 1, 2013 Accepting new patients
Orthopedic Specialists of Newport Beach Past Accepting new patients
Hoag Memorial Hospital Presbyterian Past Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients

Locations

22 Corporate Plaza Dr
Newport Beach, CA 92660
Phone (949) 472-2703

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: russell.petrie.p1@direct.newportortho.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hoag Orthopedic Institute, LLCIrvine, CA, CCN 050769 Hospital Corporate Director
Other (2.21%)		 Jan 6, 2025
Sep 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581897600000",
    "number": "1730119074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 CORPORATE PLAZA DR",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607901",
            "telephone_number": "949-722-7038",
            "fax_number": "949-630-4935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 CORPORATE PLAZA DR",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607901",
            "telephone_number": "949-722-7038",
            "fax_number": "949-630-4935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "RUSSELL",
        "middle_name": "SEAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "G85402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.