Moritz Sebastian Pettenkofer, MD

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

SPI621 Issued in CA

Practice address

200 Stein Plaza Driveway 3Rd Floor
Los Angeles, CA 90095-0001

Phone

(310) 206-5004

NPI assigned

Jun 13, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Ophthalmology

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jules Stein Eye Institute Medical GroupGroup PAC ID 5597663740, 118 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ronald Reagan UCLA Medical Center Hospital, Los Angeles, CA, CCN 050262

Merit-based Incentive Payment System (MIPS)

Final score

86.31 of 100Reported as group

Quality

78.96

Promoting interoperability

100

Improvement activities

40

Cost

71.72

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpettenkofer729742@direct.uclahealth.org

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.

• Jules Stein Eye Institute Medical Group

  • Ophthalmology Physician
  • Los Angeles, CA
  • NPI 1326006966

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Jules Stein Eye Institute Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Fountain Valley, CA
  • NPI 1770938292
  NPD
• UCLA Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1043427248
  NPD (past)

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

• Regents Univ of Calif Los Angeles

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1902803315
  Care Compare affiliation

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

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1194455188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631",
            "telephone_number": "310-301-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 STEIN PLAZA DRIVEWAY 3RD FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900950001",
            "telephone_number": "310-206-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTENKOFER",
        "first_name": "MORITZ",
        "middle_name": "SEBASTIAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-13",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "CA",
            "license": "SPI621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://profiles.ucla.edu/moritz.pettenkofer",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "200 Stein Plaza Driveway 3rd Floor",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900950001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nataly Seka Petrovic, LCSW
• Madalyn Marie Petrovich, M.S., CCC-SLP
• Henrik Petrowsky, MD
• Richard Edward Petrucci Jr., MD
• Bertha Alexis Pettaway, LCSW
• Regina Petterson, PSY.D.
• Andrea Marie Pettett, ACSW
• Gayane Elizabeth Pettibone
• Angela Pettinelli
• Lisa Jo Pettinelli, RRT, RN

• Retina Specialist (Ophthalmology) Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Retina Specialist (Ophthalmology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.