Shannon Petukhov, MD in Annapolis, MD - Medicare Emergency Medicine

Shannon Petukhov, MD is a medicare enrolled "Emergency Medicine" physician in Annapolis, Maryland. Her current practice location is 2001 Medical Pkwy, Annapolis, Maryland. You can reach out to her office (for appointments etc.) via phone at (443) 481-1366.

Shannon Petukhov is licensed to practice in Maryland (license number D0087812) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1427402627.

Contact Information

	Shannon Petukhov, MD
	2001 Medical Pkwy, Annapolis, MD 21401-3773
	(443) 481-1366
	Not Available

Map and Direction

Physician's Profile

Full Name	Shannon Petukhov
Gender	Female
Speciality	Emergency Medicine
Location	2001 Medical Pkwy, Annapolis, Maryland
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1427402627
Provider Enumeration Date: 04/14/2016
Last Update Date: 02/06/2020

Medicare PECOS Information:

PECOS PAC ID: 3779877055
Enrollment ID: I20191023003627

Medical Identifiers

Medical identifiers for Shannon Petukhov such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1427402627	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207P00000X	Emergency Medicine	D0087812 (Maryland)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shannon Petukhov allows following entities to bill medicare on her behalf.

Entity Name	Doctors Emergency Service, Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1528171840 PECOS PAC ID: 4486644598 Enrollment ID: O20040512001075

Entity Name	Luminis Health Medical Group, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1073580205 PECOS PAC ID: 2860447315 Enrollment ID: O20050317000146

Entity Name	Chester River Hospital Center
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1679536809 PECOS PAC ID: 0749220671 Enrollment ID: O20050510000504

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. Shannon Petukhov 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
Shannon Petukhov, MD 110 South Paca Street 6 Fl. Suite 200, Baltimore, MD 21201-1645 Ph: () -	Shannon Petukhov, MD 2001 Medical Pkwy, Annapolis, MD 21401-3773 Ph: (443) 481-1366

Reviews and Comments

Emergency Medicine Doctors in Annapolis, MD

Dr. Cornelius Van Der Meer Stamp, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 821 Bay Ridge Ave, Apt A, Annapolis, MD 21403 Phone: 410-268-9590
Bailey E Lewis, ATC Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 566 Brownson Rd, Annapolis, MD 21402 Phone: 269-319-9216
Lee A. Goodman, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 79 West St, Annapolis, MD 21401 Phone: 410-268-3627 Fax: 410-267-6372
Jared Kartchner Heal, DO, UMO/DMO USN Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 121 Blake Rd, Annapolis, MD 21402 Phone: 710-293-1706
Caitlin Mase, Emergency Medicine Medicare: Medicare Enrolled Practice Location: 2001 Medical Pkwy, Annapolis, MD 21401 Phone: 443-481-1366
Frederick K Goodwin, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 2001 Medical Pkwy, Annapolis, MD 21401 Phone: 443-481-1366
Joseph A Halpern, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 2001 Medical Pkwy, Annapolis, MD 21401 Phone: 443-481-1366

Shannon Petukhov, MD - Medicare Emergency Medicine in Annapolis, MD