Active NPI
Sherri Petrucci, PA-C
- Family Medicine Physician
- Mannington, WV
National Provider Identifier
1851485791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 116
- Practice address
- 800 E Main St
Suite B
Mannington, WV 26582-1215 - Phone
- (304) 986-2996
- Fax
- (304) 986-2998
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 116 | WV | Primary |
Addresses
Primary practice location
800 E Main St
Suite B
Mannington, WV 26582-1215
Mailing address
800 E Main St
Suite B
Mannington, WV 26582-1215
Phone (304) 986-2996
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810000520 | Medicaid | WV | |
| 003189133 | Other | WV | BLUE CROSS |
| P01447170 | Other | WV | RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Bridgeport, WV
- NPI 1386019222
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469664000000",
"number": "1851485791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 E MAIN ST",
"address_2": "SUITE B",
"city": "MANNINGTON",
"state": "WV",
"postal_code": "265821215",
"telephone_number": "304-986-2996",
"fax_number": "304-986-2998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E MAIN ST",
"address_2": "SUITE B",
"city": "MANNINGTON",
"state": "WV",
"postal_code": "265821215",
"telephone_number": "304-986-2996",
"fax_number": "304-986-2998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUCCI",
"first_name": "SHERRI",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2016-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WV",
"license": "116",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810000520",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "003189133",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "P01447170",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mannington, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.