NPIMap

Individual provider Active NPI

Jacob A Petrosky, MD

  • Surgery Physician
  • Danville, PA
National Provider Identifier
1881959013
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
ME149924 Issued in FL
Practice address
100 North Academy Ave
Danville, PA 17822
Phone
(570) 271-6361
NPI assigned
Jul 13, 2012
Reactivated
Jun 16, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OH
Surgery Physician 208600000X 35.126975 OH
Surgery Physician 208600000X MD459469 PA
Surgery Physician 208600000X ME149924 FL Primary
Surgery Physician 208600000X 32954 MS
Hospitalist Physician 208M00000X 35.126975 OH
Surgery Physician 208600000X 69473 TN

Addresses

Primary practice location

100 North Academy Ave
Danville, PA 17822

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other practice location 1

4240 Bethel Rd Ste 200
Olive Branch, MS 38654-8737
Phone (901) 758-7970

Other practice location 2

13207 Ravenna Rd
Chardon, OH 44024-7032
Phone (440) 214-3111 ext. 2

Other practice location 3

793 W State St
Dept of Education - Surgery
Columbus, OH 43222-1551
Phone (913) 667-9099

Other practice location 4

1325 Eastmoreland Ave Ste 310
Memphis, TN 38104-7544
Phone (901) 758-7970

Other names 1

  • Dr. Jake Petrosky Other name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jacobpetrosky@uhps.allscriptsdirect.net
Direct Messaging Address jacobpetrosky@uhps.allscriptsdirect.net Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MT, MS, TN, WA5 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20210915001241 TX Practitioner - General Surgery 9931351707 Reassigns benefits to 1 organization
I20231129002197 MT Practitioner - General Surgery 9931351707 Reassigns benefits to 1 organization
I20240308001909 MS Practitioner - General Surgery 9931351707 Reassigns benefits to 1 organization
I20240313000572 TN Practitioner - General Surgery 9931351707 Reassigns benefits to 1 organization
I20240710002937 WA Practitioner - General Surgery 9931351707 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Kansas School of Med (KC/Wich/Sal), 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1204 Seward Ave
Searhc 1204 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1206 Seward Ave
Searhc 1206 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1209 Seward Ave
Searhc 1209 Behavioral
Sitka, AK 99835-7359
Phone (907) 966-8611

222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

227 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

435 S Crystal St
Suite 220
Butte, MT 59701-1506
Phone (406) 496-3600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy20
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux24
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32954MSMDSurgery Physician
35.126975OHMDSurgery Physician
MD459469PAMDSurgery Physician
69473TNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium CurrentSince Sep 10, 2021 Accepting new patients
Multicare Health System Current Accepting new patients
Ut Methodist Physicians LLC Surgery CurrentSince Apr 22, 2024 Accepting new patients
SCL Health Medical Group-Butte LLC CurrentSince Aug 22, 2025 Accepting new patients
Multicare Health System CurrentSince Oct 1, 2025 Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Sep 10, 2021 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Multicare Health System CurrentSince Oct 1, 2025 Accepting new patients
Ut Medical Group Inc Surgery PastSince Apr 22, 2024 Accepting new patients

Locations

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423

4250 Bethel Rd
Olive Branch, MS 38654
Phone (662) 932-9000

4240 Bethel Rd
Ste 200
Olive Branch, MS 38654
Phone (901) 758-7970

435 S Crystal St
Ste 400
Butte, MT 59701
Phone (406) 496-3456

435 S Crystal St
Ste 200
Butte, MT 59701
Phone (406) 496-3480

400 S Clark St
Butte, MT 59701
Phone (406) 495-7260

435 S Crystal St
Ste 220
Butte, MT 59701
Phone (406) 496-3600

1211 Union Ave
Ste 330
Memphis, TN 38104
Phone (901) 478-0954

1325 Eastmoreland Ave
Ste 310
Memphis, TN 38104
Phone (901) 272-6010

1325 Eastmoreland Ave
Ste 370
Memphis, TN 38104
Phone (901) 516-8785

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

Interoperability endpoints

  • Direct secure messaging: jpetrosky337914@mhsdirect.net
  • Direct secure messaging: jpetrosky43698@mlh.direct-ci.com

Organizations & group practices 9

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 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1881959013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NORTH ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "17822",
            "telephone_number": "570-271-6361"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4240 Bethel Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Olive Branch",
            "state": "MS",
            "postal_code": "386548737",
            "country_code": "US",
            "telephone_number": "901-758-7970",
            "fax_number": "901-266-6425",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13207 Ravenna Rd",
            "address_purpose": "LOCATION",
            "city": "Chardon",
            "state": "OH",
            "postal_code": "440247032",
            "country_code": "US",
            "telephone_number": "440-214-3111 x2",
            "fax_number": "216-201-8683",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "793 W State St",
            "address_2": "Dept of Education - Surgery",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432221551",
            "country_code": "US",
            "telephone_number": "913-667-9099",
            "fax_number": "913-624-1922",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1325 Eastmoreland Ave Ste 310",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381047544",
            "country_code": "US",
            "telephone_number": "901-758-7970",
            "fax_number": "901-266-6425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETROSKY",
        "first_name": "JACOB",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-13",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "deactivation_date": "2025-05-15",
        "reactivation_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35.126975",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD459469",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME149924",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MS",
            "license": "32954",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35.126975",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "69473",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacobpetrosky@uhps.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "890 W State St",
            "address_2": "Ste 201",
            "city": "Geneva",
            "state": "OH",
            "country_code": "US",
            "postal_code": "44041",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacobpetrosky@uhps.allscriptsdirect.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "890 W State St",
            "address_2": "Ste 201",
            "city": "Geneva",
            "state": "OH",
            "country_code": "US",
            "postal_code": "44041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JAKE",
            "last_name": "PETROSKY",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Danville, PA

Sources for this page

Verify at the official NPI Registry.