NPIMap

Individual provider Active NPI

Justin J Petrolla, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Bethel Park, PA
National Provider Identifier
1932305893
Registry record updated Jan 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
MD433757 Issued in PA
Practice address
2000 Oxford Dr
Suite 211
Bethel Park, PA 15102-1827
Phone
(412) 283-0260
Fax
(412) 283-0700
NPI assigned
Jun 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X MD433757 PA Primary

Addresses

Primary practice location

2000 Oxford Dr
Suite 211
Bethel Park, PA 15102-1827

Mailing address

2000 Oxford Dr
Suite 211
Bethel Park, PA 15102-1827
Phone (412) 283-0260

Other identifiers 1

IdentifierTypeStateIssuer
1026307660001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20080730000173 PA Practitioner - Physical Medicine and RehabilitationPractitioner - Pain ManagementPractitioner - Interventional Pain ManagementPractitioner - AnesthesiologyPractitioner - Sports Medicine 6204900954 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Pain Management, Sports Medicine
Education
Northeastern Ohio University College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Hills Orthopaedic Surgery Associates, PCGroup PAC ID 8921045774, 22 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

2000 Oxford Dr
Suite 211
Bethel Park, PA 15102-1898
Phone (412) 283-0260

2000 Westinghouse Dr
Cranberry Township, PA 16066-5238

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
South Hills Orthopaedic Surgery Associates, PC Pain Medicine CurrentSince Feb 1, 2017 Accepting new patients
South Hills Orthopaedic Surgery Associates, PC CurrentSince Feb 1, 2017 Accepting new patients

Locations

2000 Oxford Dr
Ste 211
Bethel Park, PA 15102
Phone (412) 283-0260

100 Siena Dr
Ste 165
Upper St Clair, PA 15241
Phone (412) 283-0260

Organizations & group practices 2

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 7

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": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485388800000",
    "number": "1932305893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 OXFORD DR",
            "address_2": "SUITE 211",
            "city": "BETHEL PARK",
            "state": "PA",
            "postal_code": "151021827",
            "telephone_number": "412-283-0260",
            "fax_number": "412-283-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 OXFORD DR",
            "address_2": "SUITE 211",
            "city": "BETHEL PARK",
            "state": "PA",
            "postal_code": "151021827",
            "telephone_number": "412-283-0260",
            "fax_number": "412-283-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROLLA",
        "first_name": "JUSTIN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-26",
        "last_updated": "2017-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "PA",
            "license": "MD433757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026307660001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethel Park, PA

Sources for this page

Verify at the official NPI Registry.