Tatyana Petrosova, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

2002007108 Issued in MO

Practice address

10420 Old Olive Street Rd Ste 305
Saint Louis, MO 63141-5914

Phone

(314) 797-7074

Fax

(314) 227-5505

NPI assigned

Feb 1, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Nephrology

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tatyana Petrosova MD PCGroup PAC ID 4082757034, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• DaVita Lake St. Louis Home At Home Dialysis facility, Lake Saint Louis, MO, CCN 262641
• DaVita Hazelwood Dialysis Dialysis facility, Hazelwood, MO, CCN 262589
• DaVita Lake St Louis Dialysis Dialysis facility, Lake Saint Louis, MO, CCN 262541
• DaVita North St Louis County Dialysis Dialysis facility, Florissant, MO, CCN 262625
• SSM St Joseph Health Center Hospital, Saint Charles, MO, CCN 260005
• SSM St Joseph Hospital West Hospital, Lake Saint Louis, MO, CCN 260200
• Progress West Hospital Hospital, Ofallon, MO, CCN 260219
• SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104
• Barnes-Jewish St Peters Hospital Hospital, Saint Peters, MO, CCN 260191

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d
• IA HMO
• IA HMO C-SNP

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.

• Tatyana Petrosova, MD PC

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1700026515
  Medicare reassignment Care Compare group Authorized official
• Olympic Rehab Wellness and Pain Center PC

  • Pain Medicine Physician
  • Saint Louis, MO
  • NPI 1669484119
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dva Renal Healthcare Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hazelwood, MO
  • NPI 1194786814

  Dialysis facility

  Care Compare affiliation Name & address match
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Lake Saint Louis, MO
  • NPI 1396074597

  Dialysis facility

  Care Compare affiliation Name & address match
• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Florissant, MO
  • NPI 1679764864

  Dialysis facility

  Care Compare affiliation Name & address match
• Barnes Jewish St Peters Hospital Inc

  • General Acute Care Hospital
  • Saint Peters, MO
  • NPI 1144238908
  Care Compare affiliation
• Progress West Healthcare Center

  • General Acute Care Hospital
  • O Fallon, MO
  • NPI 1508938044
  Care Compare affiliation
• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Saint Charles, MO
  • NPI 1467521146
  Care Compare affiliation
• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Bridgeton, MO
  • NPI 1598835308
  Care Compare affiliation
• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Lake St Louis, MO
  • NPI 1871665380
  Care Compare affiliation

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717891200000",
    "number": "1023089562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 653",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630060653",
            "telephone_number": "314-797-7074",
            "fax_number": "314-227-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10420 OLD OLIVE STREET RD STE 305",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415914",
            "telephone_number": "314-797-7074",
            "fax_number": "314-227-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSOVA",
        "first_name": "TATYANA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-01",
        "last_updated": "2024-06-09",
        "certification_date": "2024-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "2002007108",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036107203",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207235706",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Leigh Petroff, RN BSN
• Emily Ann Petroline, PHARM D
• Giulia Eva Maria Petrone, MD
• Jessica S Petrone, MD
• Emiko Petrosky, M.D.
• Robert Ara Petrossian, MD
• Mirjana Petrovic Elbaz, MD
• Jack Parker Petrucci
• Orlando Petrucci, MD
• Zachary Michael Petruso, DC

• Nephrology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Nephrology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2024; 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.