NPIMap

Individual provider Active NPI

George A. Petrossian, M.D.

  • Specialist
  • Roslyn, NY
National Provider Identifier
1821093444
Registry record updated Sep 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
159502-1 Issued in NY
Practice address
1405 Old Northern Blvd
Roslyn, NY 11576-2252
Phone
(516) 484-6777
Fax
(516) 484-0037
NPI assigned
Jun 20, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 159502-1 NY Primary

Addresses

Primary practice location

1405 Old Northern Blvd
Roslyn, NY 11576-2252

Mailing address

PO Box 95000-6600
Philadelphia, PA 19195-6600
Phone (631) 465-6297

Other identifiers 13

IdentifierTypeStateIssuer
1047935OtherNYAETNA USHC-HMO
2198834OtherNYGHI/FLEX SELECT/PPO
85F031OtherNYBCBS - PROVIDER I.D.
159502 AND 28446POtherNYHIP - PROVIDER I.D.
4221943OtherNYAETNA USHC - NON HMO
ZS068OtherNYOXFORD - PROVIDER I.D.
000000067277OtherNYGHI/HMO PROVIDER I.D.
1210804OtherNYUNITED HEALTHCARE
2C8634OtherNYHEALTHNET - PROVIDER I.D.
05405GOtherNYGHI MEDICARE (QUEENS)
19684OtherNYVYTRA - PROVIDER I.D.
01848737MedicaidNY
3986056009OtherNYCIGNA - PROVIDER I.D.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20050224000615 NY Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 4789637299 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Icahn School of Medicine at Mount Sinai, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

1405 Old Northern Blvd
Roslyn, NY 11576-2252
Phone (516) 484-6777

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting92
Leg revascularization (restoring blood flow)14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
159502-1NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Physician Partners, PC Current Accepting new patients
CHS Physician Partners, P.C CurrentSince Jan 1, 2016 Accepting new patients
CHS Physician Partners, PC Past Accepting new patients
St. Francis Hospital Past Accepting new patients
My CHS RX Inc. Past Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients
Cardiothoracic Surgery PC PastSince Jul 1, 1999 Accepting new patients

Locations

2200 Northern Blvd
Ste 112
Greenvale, NY 11548
Phone (516) 484-6777

2200 Northern Blvd
Ste 102
Greenvale, NY 11548

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

1 Healthy Way
Oceanside, NY 11572
Phone (516) 255-1581

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
#G1
Roslyn, NY 11576
Phone (516) 627-2173

100 Port Washington Blvd
Ste G1
Roslyn, NY 11576
Phone (516) 327-2173

1405 Old Northern Blvd
Roslyn, NY 11576
Phone (516) 484-6777

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: gpetrossian23718@direct-chsli.net
  • FHIR API: https://api.platform.athenahealth.com/21626/brand/2/csg/1/fhir/r4

Organizations & group practices 7

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.

Hospital & facility affiliations 9

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": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1821093444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95000-6600",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191956600",
            "telephone_number": "631-465-6297",
            "fax_number": "631-465-6524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 OLD NORTHERN BLVD",
            "city": "ROSLYN",
            "state": "NY",
            "postal_code": "115762252",
            "telephone_number": "516-484-6777",
            "fax_number": "516-484-0037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSSIAN",
        "first_name": "GEORGE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "159502-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USHC-HMO",
            "identifier": "1047935",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI/FLEX SELECT/PPO",
            "identifier": "2198834",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - PROVIDER I.D.",
            "identifier": "85F031",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP - PROVIDER I.D.",
            "identifier": "159502 AND 28446P",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USHC - NON HMO",
            "identifier": "4221943",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD - PROVIDER I.D.",
            "identifier": "ZS068",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI/HMO PROVIDER I.D.",
            "identifier": "000000067277",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1210804",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET - PROVIDER I.D.",
            "identifier": "2C8634",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI MEDICARE (QUEENS)",
            "identifier": "05405G",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA - PROVIDER I.D.",
            "identifier": "19684",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01848737",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA - PROVIDER I.D.",
            "identifier": "3986056009",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roslyn, NY

Sources for this page

Verify at the official NPI Registry.