Ekaterina Nikolaevna Petrova, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A127080 Issued in CA

Practice address

1510 Florida Ave
Modesto, CA 95350-4437

Phone

(209) 549-7090

Fax

(209) 549-7099

NPI assigned

May 17, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Golden Valley Health Centers

  • Federally Qualified Health Center (FQHC)
  • Turlock, CA
  • NPI 1356445753
  Medicare reassignment NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Planada, CA
  • NPI 1235114745
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Ceres, CA
  • NPI 1316393010
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1346224417
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Le Grand, CA
  • NPI 1356325310
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Merced, CA
  • NPI 1508333253
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1518298306
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Merced, CA
  • NPI 1528042512
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Newman, CA
  • NPI 1689658668
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Los Banos, CA
  • NPI 1730163734
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Dos Palos, CA
  • NPI 1770567778
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Westley, CA
  • NPI 1770568347
  NPD

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

{
    "created_epoch": "1274054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1265750129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 W CHILDS AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953416805",
            "telephone_number": "209-384-6493",
            "fax_number": "209-383-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 FLORIDA AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504437",
            "telephone_number": "209-549-7090",
            "fax_number": "209-549-7099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROVA",
        "first_name": "EKATERINA",
        "middle_name": "NIKOLAEVNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-17",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "042-0011975",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A127080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Isabel Petit
• Janet L Petrides, RNFA
• Nyssa Petriz
• Cheril Nicole Petroni
• Joseph Lido Petroni II, LMFT
• Jonathan Matthew Pettegrew, D.O.
• Clair L. Pettinger, MD
• Monique Pettis, M.A., ED.S., PPS
• Sofia Ekaterina Pettygrove
• Katherine Marcela Pettyjohn, FNP-BC

• Pediatrics Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; 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.