Dr Ivan D Petrich, DO is a medicare enrolled "Family Medicine" physician in Jbsa-randolph, Texas. His current practice location is
221 3rd Street West, Jbsa-randolph, Texas. You can reach out to his office (for appointments etc.) via phone at
(210) 652-6550.
Dr Ivan D Petrich is licensed to practice in North Carolina (license number 2019-01392) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1639527096.
Physician's Profile
| Full Name | Dr Ivan D Petrich |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 221 3rd Street West, Jbsa-randolph, Texas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1639527096
- Provider Enumeration Date: 05/26/2016
- Last Update Date: 07/21/2022
Medicare PECOS Information:
- PECOS PAC ID: 2668765660
- Enrollment ID: I20160728001689
Medical Identifiers
Medical identifiers for Dr Ivan D Petrich such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1639527096 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 2083A0100X | Preventive Medicine - Aerospace Medicine | 2019-01392 (North Carolina) | Secondary |
| 207Q00000X | Family Medicine | 2019-01392 (North Carolina) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Ivan D Petrich is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Ivan D Petrich, DO
48th Medical Group, Raf Lakenheath - Unit 5115,
Apo Ae, SUFFOLK 09461-5115
Ph: () - | Dr Ivan D Petrich, DO
221 3rd Street West,
Jbsa-randolph, TX 78150
Ph: (210) 652-6550 |
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