Active NPI
Richard A Petrak, M.D.
- Pulmonary Disease Physician
- Berwyn, IL
National Provider Identifier
1891708608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 036072033
- Practice address
- 3231 Euclid Ave
Suite 405
Berwyn, IL 60402-3471 - Phone
- (708) 783-2644
- Fax
- (708) 783-3973
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 036072033 | IL | |
| Pulmonary Disease Physician | 207RP1001X | 036072033 | IL | Primary |
Addresses
Primary practice location
3231 Euclid Ave
Suite 405
Berwyn, IL 60402-3471
Mailing address
3231 Euclid Ave
Suite 405
Berwyn, IL 60402-3471
Phone (708) 783-2644
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036072033 | Medicaid | IL | |
| 36072033 | Other | IL | STATE OF ILLINOIS LICENSE |
| P00062672 | Other | IL | RAILROAD MEDICARE PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041208001177 | IL | Practitioner - Pulmonary Disease | 9032175286 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298937600000",
"number": "1891708608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3231 EUCLID AVE",
"address_2": "SUITE 405",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023471",
"telephone_number": "708-783-2644",
"fax_number": "708-783-3973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3231 EUCLID AVE",
"address_2": "SUITE 405",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023471",
"telephone_number": "708-783-2644",
"fax_number": "708-783-3973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRAK",
"first_name": "RICHARD",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2011-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "IL",
"license": "036072033",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "IL",
"license": "036072033",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036072033",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF ILLINOIS LICENSE",
"identifier": "36072033",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PIN",
"identifier": "P00062672",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; 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.