Elena Petrusevska, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085-004506 Issued in IL

Practice address

840 W Irving Park Rd
Ste 301
Chicago, IL 60613-3011

Phone

(773) 975-3269

Fax

(773) 975-3270

NPI assigned

Dec 14, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Health Service Systems, Inc

  • Internal Medicine Physician
  • New Lenox, IL
  • NPI 1851323257
  Medicare reassignment NPD
• Health Service Systems, Inc

  • Urgent Care Clinic/Center
  • Mokena, IL
  • NPI 1578235800
  NPD

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

{
    "created_epoch": "1355443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442448000000",
    "number": "1013253384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3276",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477313276",
            "telephone_number": "812-473-0181",
            "fax_number": "812-473-5822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 W IRVING PARK RD",
            "address_2": "STE 301",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133011",
            "telephone_number": "773-975-3269",
            "fax_number": "773-975-3270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSEVSKA",
        "first_name": "ELENA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-14",
        "last_updated": "2015-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-004506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF IL LICENSE",
            "identifier": "085-004506",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Polina V Petrovic, MD
• Natalie Jo Petrovich, PSY.D.
• Diane Elizabeth Petrow, D.C.
• Emily Marie Petrucci
• Vaidotas Petrus, MD
• Taylor Petrusevski, MD
• Kalyna Petrusha, PA-C
• Erin Petrusic, APN, PMHNP
• Elizabeth Petruzzi
• Garrett Petry, PT, DPT

• Medical Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.