Brian Alexander Petrie, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A145604 Issued in CA

Practice address

555 E Tachevah Dr Ste 2E107
Palm Springs, CA 92262-5752

Phone

(760) 561-7373

Fax

(760) 327-5140

NPI assigned

May 3, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Loma Linda University School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment Care Compare group NPD
• First Choice Physician Partners

  dba Greater Modesto Medical Surgical Associates

  • Neurological Surgery Physician
  • Modesto, CA
  • NPI 1104183052
  NPD
• First Choice Physician Partners

  • Family Medicine Physician
  • Palm Springs, CA
  • NPI 1558797118
  NPD
• First Choice Physician Partners

  dba De La Pena Eye Clinic, A Medical Group

  • Ophthalmology Physician
  • El Monte, CA
  • NPI 1912732892
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Hemet, CA
  • NPI 1013433465
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

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

{
    "created_epoch": "1430611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1952788549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 E TACHEVAH DR STE 2E107",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922625752",
            "telephone_number": "760-561-7373",
            "fax_number": "760-327-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E TACHEVAH DR STE 2E107",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922625752",
            "telephone_number": "760-561-7373",
            "fax_number": "760-327-5140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1150 N Indian Canyon Dr",
            "address_purpose": "LOCATION",
            "city": "Palm Springs",
            "state": "CA",
            "postal_code": "922624872",
            "country_code": "US",
            "telephone_number": "760-323-6511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "BRIAN",
        "middle_name": "ALEXANDER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-03",
        "last_updated": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A145604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Peter M. Jamieson, M.D., Inc
• Kimberly Peters
• Maureen Bastien Petersen
• Andrew Petras, OD
• John C Petricciani, M.D.
• Richard K Pettit, RNFA
• Anna Mercedes Peyton Navarrete, PHARMD
• Lisa Pfefferkorn, CRNA
• William J Phaklides II, M.D.
• Huy Nhat Pham

• Family Medicine Physician in Palm Springs, CA
• Providers in Palm Springs, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.