NPIMap

Individual provider Active NPI

Tatyana Petrosova, MD

  • Nephrology Physician
  • Saint Louis, MO
National Provider Identifier
1023089562
Registry record updated Jun 9, 2024
On this page

Key facts

NPPES NPI Registry
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
Last updated
Jun 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 2002007108 MO Primary
Nephrology Physician 207RN0300X 036107203 IL

Addresses

Primary practice location

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

Mailing address

PO Box 653
Chesterfield, MO 63006-0653
Phone (314) 797-7074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100130000058 MO Practitioner - Nephrology 1052397874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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)

100 Medical PLZ
Lake Saint Louis, MO 63367-1366
Phone (636) 625-5200

1021 Wentzville Pkwy
Wentzville, MO 63385-3437
Phone (314) 797-7074

10420 Old Olive St Rd
Suite 305
Saint Louis, MO 63141-5914
Phone (314) 797-7074

12303 Depaul Dr
Bridgeton, MO 63044-2512
Phone (314) 209-8814

12380 Natural Bridge Rd
Bridgeton, MO 63044-2019
Phone (800) 881-5101

13119 New Halls Ferry Rd
Florissant, MO 63033-3228
Phone (866) 544-6741

2 Progress Point Pkwy
O Fallon, MO 63368-2205
Phone (636) 344-1000

200 Brevco PLZ
Suite 202
Lake Saint Louis, MO 63367-2950
Phone (636) 561-4799

2655 Muegge Rd
Suite 102
Saint Charles, MO 63303-3145
Phone (636) 447-2490

300 1St Capitol Dr
Saint Charles, MO 63301-2844
Phone (314) 768-3450

555 N New Ballas Rd
Saint Louis, MO 63141-6825
Phone (314) 872-9272

637 Dunn Rd
Suite 125
Hazelwood, MO 63042-1757
Phone (866) 544-6741

6865 Parker Rd
Florissant, MO 63033-5312
Phone (800) 881-5101

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Olympic Rehab Wellness and Pain Center PC CurrentSince Jun 16, 2024 Accepting new patients

Locations

10420 Old Olive Street Rd
Ste 305
Saint Louis, MO 63141
Phone (314) 797-7074

Networks

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

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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

NPI Registry JSON

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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.