Individual provider Active NPI

Steven Petronijevic, DO

  • Family Medicine Physician
  • Salinas, CA
National Provider Identifier
1790774560
Registry record updated May 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A5244 Issued in CA
Practice address
17615 Moro Rd
Salinas, CA 93907-8541
Phone
(831) 663-3926
Fax
(831) 663-0605
NPI assigned
Oct 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A5244 CA Primary

Addresses

Primary practice location

17615 Moro Rd
Salinas, CA 93907-8541

Mailing address

17615 Moro Rd
Salinas, CA 93907-8541
Phone (831) 663-3926

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20050726001081 CA Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 5092742569 Practice locations: Prunedale, CA

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A5244CAMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432684800000",
    "number": "1790774560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17615 MORO RD",
            "city": "SALINAS",
            "state": "CA",
            "postal_code": "939078541",
            "telephone_number": "831-663-3926",
            "fax_number": "831-663-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17615 MORO RD",
            "city": "SALINAS",
            "state": "CA",
            "postal_code": "939078541",
            "telephone_number": "831-663-3926",
            "fax_number": "831-663-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRONIJEVIC",
        "first_name": "STEVEN",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2015-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A5244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salinas, CA

Sources for this page

Verify at the official NPI Registry.