Individual ProviderJohn PetrilliFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address13330 Usf Laurel Dr, Tampa, FL 33612-6601(813) 974-2201PECOS EnrollmentBased on the most recent information from CMS, provider John Petrilli is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1609213016Provider TypeIndividualFull NamePetrilli, JohnTitleDr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date5/24/2013Last Updated9/11/2020Contact InformationPractice LocationPractice Address13330 Usf Laurel Dr, Tampa, FL 33612-6601Phone(813) 974-2201FaxUnlisted FaxMailing LocationMailing AddressPO Box 917770, Orlando, FL 32891-0001PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseME120968FloridaProvider IdentifiersIDDescriptionIssuerID016722000DescriptionMedicaidIssuerUnlistedFloridaIDL8J51DescriptionOtherIssuerBLUE CROSS BLUE SHIELDFlorida