Joseph W Petrie, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1129 Issued in ID

Practice address

431 E. Main St.
#994
Challis, ID 83226

Phone

(208) 833-3773

Fax

(833) 839-1175

NPI assigned

Nov 18, 2013

Last updated

Feb 2, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Petrie Family Enterprises PCGroup PAC ID 2163872029, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Steele Memorial Medical Center Hospital, Salmon, ID, CCN 131305
• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jpetrie1004540@wm.providencedirect.org

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.

• Petrie Family Enterprises, PC

  dba White Cloud Wellness

  • Family Medicine Physician
  • Challis, ID
  • NPI 1396290953
  Medicare reassignment Care Compare group Authorized official
• Orthopedic & Fracture Clinic PA

  dba West Idaho Orthopedics & Sports Medicine

  • Specialist
  • Caldwell, ID
  • NPI 1184739351
  NPD (past)

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

• Pocatello Hospital LLC

  dba Portneuf Rehabilitation Center

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Medical Center

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation
• Steele Memorial Medical Center

  • Critical Access Hospital
  • Salmon, ID
  • NPI 1851403265
  Care Compare affiliation

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

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643760000000",
    "number": "1851721401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 E. MAIN ST.",
            "address_2": "#994",
            "city": "CHALLIS",
            "state": "ID",
            "postal_code": "83226",
            "telephone_number": "208-833-1313",
            "fax_number": "833-839-1175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 E. MAIN ST.",
            "address_2": "#994",
            "city": "CHALLIS",
            "state": "ID",
            "postal_code": "83226",
            "telephone_number": "208-833-3773",
            "fax_number": "833-839-1175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "JOSEPH",
        "middle_name": "W",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-18",
        "last_updated": "2022-02-02",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Suyanti Muliawan, PA-C
• North Custer Hospital District
• Patricia Hyatt PT LLC (Garden Creek Physical Therapy)
• Petrie Family Enterprises, PC (White Cloud Wellness)
• Breeann Marie Petrie, PA-C
• Rainbow's End Recovery Center LLC
• Cynthia Lee Rathmann, DC
• Sharon Rotax, LMSW
• Round Valley Rehabilitation
• Crystal Marie Smalley, LCSW-I, LMSW

• Physician Assistant in Challis, ID
• Providers in Challis, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.