NPIMap

Individual provider Active NPI

Tracy Leticia Petrilli, PA-C

  • Physician Assistant
  • Spartanburg, SC
National Provider Identifier
1831842095
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4263 Issued in SC
Practice address
218 E Blackstock Rd
Spartanburg, SC 29301-2607
Phone
(864) 576-8646
NPI assigned
Jan 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4263 SC Primary

Addresses

Primary practice location

218 E Blackstock Rd
Spartanburg, SC 29301-2607

Mailing address

618 Elwood Drive
Duncan, SC 29334
Phone (407) 257-6988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20220331002414 SC Practitioner - Physician Assistant 1355737230 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, shared by 17 NPIs, 1,060 clinicians

Practice addresses (Care Compare)

2660 Reidville Rd
Unit 1
Spartanburg, SC 29301-3512
Phone (864) 560-9696

2995 Reidville Rd
Suite 100
Spartanburg, SC 29301-5600
Phone (864) 587-3000

3611 Pelham Rd
Greenville, SC 29615-5002
Phone (864) 530-3500

511 Cross Anchor Rd
Woodruff, SC 29388-2328
Phone (864) 278-6031

853 N Church St
Suite 410a
Spartanburg, SC 29303-3098
Phone (864) 560-6928

Hospital & facility affiliations

  • Spartanburg Medical Center Hospital, Spartanburg, SC, CCN 420007
  • Anmed Health Hospital, Anderson, SC, CCN 420027

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
4263SCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center CurrentSince Jun 1, 2023 Accepting new patients
Cherokee Medical Center CurrentSince Jun 1, 2023 Accepting new patients
Spartanburg Medical Center CurrentSince Jun 1, 2023 Accepting new patients
Spartanburg Medical Center CurrentSince Jun 1, 2023 Accepting new patients
Spartanburg Medical Center CurrentSince Sep 1, 2023 Accepting new patients
Spartanburg Medical Center Past Accepting new patients

Locations

840 W Floyd Baker Blvd
Gaffney, SC 29341
Phone (864) 489-3300

3611 Pelham Rd
Greenville, SC 29615
Phone (864) 530-3500

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

151 Peachwood Centre Dr
Spartanburg, SC 29301
Phone (864) 560-9627

1200 E Main St
Ste 12
Spartanburg, SC 29307
Phone (864) 560-9260

2995 Reidville Rd
Spartanburg, SC 29301
Phone (864) 253-8140

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

2660 Reidville Rd
Unit 1
Spartanburg, SC 29301
Phone (864) 560-9696

511 Cross Anchor Rd
Woodruff, SC 29388
Phone (864) 278-6031

Interoperability endpoints

  • Direct secure messaging: tpetrilli86667@direct.anmedhealth.net

Organizations & group practices 11

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 5

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": "1643328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1831842095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 ELWOOD DRIVE",
            "city": "DUNCAN",
            "state": "SC",
            "postal_code": "29334",
            "telephone_number": "407-257-6988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 E BLACKSTOCK RD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293012607",
            "telephone_number": "864-576-8646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRILLI",
        "first_name": "TRACY",
        "middle_name": "LETICIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.