NPIMap

Individual provider Active NPI

David Petrosian, DO

  • Family Medicine Physician
  • Tioga, ND
National Provider Identifier
1881155745
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
PT22791 Issued in ND
Practice address
810 N Welo St
Tioga, ND 58852-7157
Phone
(701) 664-3305
NPI assigned
Mar 25, 2019
Last updated
Aug 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 323480 NY
Family Medicine Physician 207Q00000X 1024538 MA
Family Medicine Physician 207Q00000X PT22791 ND Primary

Addresses

Primary practice location

810 N Welo St
Tioga, ND 58852-7157

Mailing address

810 N Welo St
Tioga, ND 58852-7157
Phone (701) 664-3368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20251114001138 ND Practitioner - Family Practice 2062861727 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tioga Medical CenterGroup PAC ID 1254390305, shared by 7 NPIs, 10 clinicians

Practice addresses (Care Compare)

810 N Welo St
Tioga, ND 58852-7157
Phone (701) 664-3305

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1024538MAMDFamily Medicine Physician
323480NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tioga Medical Center CurrentSince Sep 15, 2025 Accepting new patients
Tioga Medical Center CurrentSince Sep 15, 2025 Accepting new patients
Tioga Medical Center CurrentSince Jan 27, 2026 Accepting new patients
Tioga Medical Center CurrentSince Nov 30, 2025 Accepting new patients
Tioga Medical Center Past Accepting new patients
Tioga Medical Center Hospital Past Accepting new patients
14 Street Medical, PC PastSince Apr 1, 2025 Accepting new patients
Tioga Medical Center Past Accepting new patients
Tioga Medical Center Past Accepting new patients
Harvard Street Neighborhood Health Center Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: david.petrosian.1@8526.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/13555/brand/1/csg/1/fhir/r4

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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": "1553472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1881155745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 N WELO ST",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "588527157",
            "telephone_number": "701-664-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 N WELO ST",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "588527157",
            "telephone_number": "701-664-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSIAN",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-25",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "323480",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "1024538",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "PT22791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tioga, ND

Sources for this page

Verify at the official NPI Registry.