Jason Michael Petrungaro, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

01074460A Issued in IN

Practice address

800 Macarthur Blvd
Suite 21
Munster, IN 46321-2917

Phone

(219) 836-1163

Fax

(844) 270-6677

NPI assigned

Mar 28, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Paulino Y. Chan, MD, Inc

  • Orthopaedic Surgery Physician
  • Munster, IN
  • NPI 1790782472
  NPD (past)
• Baylor College of Medicine

  • Plastic Surgery Physician
  • Houston, TX
  • NPI 1730114125
  NPD (past)
• TMH Physician Organization

  • Plastic and Reconstructive Surgery Physician
  • Houston, TX
  • NPI 1285684431
  NPD (past)

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

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470182400000",
    "number": "1871765057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MACARTHUR BLVD",
            "address_2": "SUITE 21",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212917",
            "telephone_number": "219-836-1163",
            "fax_number": "844-270-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MACARTHUR BLVD",
            "address_2": "SUITE 21",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212917",
            "telephone_number": "219-836-1163",
            "fax_number": "844-270-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUNGARO",
        "first_name": "JASON",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-28",
        "last_updated": "2016-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "N9993",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IN",
            "license": "01074460A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8DT481",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN2244001",
            "identifier": "MEDICARE",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01602561",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IN",
            "identifier": "0914915",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Persenaire
• Doreen Marie Peterson, D.D.S.
• Rachel Ann Peterson, DDS
• Ronald D. Peterson, D.O.
• Petrungaro Plastic Surgery, LLC
• Nicole Marie Petrungaro, CRNA
• Allyson Philbin, PA-C
• Angela Bonnie Phillips, PSY.D., HSPP
• Brian Russell Phillips, PMHNP
• Physicians Optical Center LLC

• Plastic and Reconstructive Surgery Physician in Munster, IN
• Providers in Munster, IN by specialty
• Plastic and Reconstructive Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.