Individual provider Active NPI

Anna Alekseevna Petrovich, D.O.

  • Family Medicine Physician
  • Carmichael, CA
National Provider Identifier
1245331537
Registry record updated Feb 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A8324 Issued in CA
Practice address
6555 Coyle Ave
Carmichael, CA 95608-0302
Phone
(916) 536-2500
NPI assigned
Sep 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A8324 CA Primary

Addresses

Primary practice location

6555 Coyle Ave
Carmichael, CA 95608-0302

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956

Other identifiers 12

IdentifierTypeStateIssuer
00AX83240MedicaidCA
1806844OtherCAGREAT WEST
000810608129OtherCAPHCS
MCMG343900OtherCAWESTERN HEALTH ADVANTAGE
106126OtherCAHEALTH NET
2238002OtherCAFIRST HEALTH
236152OtherCAINTERPLAN
7403659OtherCAAETNA
20A8324OtherCABLUE CROSS
90141470OtherCAPACIFICARE
4441911OtherCACIGNA
5635513OtherCAFIRSTH HEALTH

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040722001093 CA Practitioner - Family Practice 2668452327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

1700 Prairie City Rd
Folsom, CA 95630-9594
Phone (916) 351-4800

1730 Prairie City Rd
Suite 120
Folsom, CA 95630-9594
Phone (916) 351-4800

3000 Q St
Sacramento, CA 95816-7058
Phone (916) 560-0319

Hospital & facility affiliations

  • Mercy Home Health Home health agency, Rancho Cordova, CA, CCN 057631
  • Your Choice Home Health, Inc Home health agency, Rancho Cordova, CA, CCN 053168
  • Mercy General Hospital Hospital, Sacramento, CA, CCN 050017
  • Mercy San Juan Medical Center Hospital, Carmichael, CA, CCN 050516
  • Sutter Roseville Medical Center Hospital, Roseville, CA, CCN 050309

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions22
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A8324CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation CurrentSince Jul 14, 2004 Accepting new patients
Dignity Health Medical Foundation CurrentSince Jul 14, 2004 Accepting new patients
Dignity Health Past Accepting new patients

Locations

3581 Palmer Dr
Ste 401
Cameron Park, CA 95682
Phone (530) 676-4122

6555 Coyle Ave
Carmichael, CA 95608
Phone (916) 536-2500

6403 Coyle Ave
Ste 250
Carmichael, CA 95608
Phone (916) 961-2820

7115 Greenback Ln
Fl 2
Citrus Heights, CA 95621
Phone (916) 536-3620

7115 Greenback Ln
Fl 3
Citrus Heights, CA 95621
Phone (916) 536-3540

8001 Madison Ave
Citrus Hts, CA 95610
Phone (916) 536-2420

7911 Laguna Blvd
Elk Grove, CA 95758
Phone (916) 683-3950

3400 Data Dr
Fl 1
Rancho Cordova, CA 95670
Phone (916) 379-2726

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

2110 Professional Dr
Ste 120
Roseville, CA 95661
Phone (916) 536-2500

8120 Timberlake Way
Ste 109
Sacramento, CA 95823
Phone (916) 681-6000

4400 Duckhorn Dr
Ste 100
Sacramento, CA 95834
Phone (916) 575-8000

3939 J St
Ste 250
Sacramento, CA 95819
Phone (916) 733-6901

3000 Q St
Sacramento, CA 95816
Phone (916) 733-5701

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329091200000",
    "number": "1245331537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6555 COYLE AVE",
            "city": "CARMICHAEL",
            "state": "CA",
            "postal_code": "956080302",
            "telephone_number": "916-536-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROVICH",
        "first_name": "ANNA",
        "middle_name": "ALEKSEEVNA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2012-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A8324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX83240",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT WEST",
            "identifier": "1806844",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "000810608129",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WESTERN HEALTH ADVANTAGE",
            "identifier": "MCMG343900",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "106126",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "2238002",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERPLAN",
            "identifier": "236152",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7403659",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "20A8324",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFICARE",
            "identifier": "90141470",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4441911",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTH HEALTH",
            "identifier": "5635513",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmichael, CA

Sources for this page

Verify at the official NPI Registry.