Meagan Petrek, A.P.R.N.
Individual provider Active NPI Nurse Practitioner · San Diego, CA
NPI 1376925974 · NPPES record last updated Feb 10, 2022
Key facts
- NPI
- 1376925974
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 95005125 (CA)
- Practice address
- 3900 Fifth Ave Ste 110
San Diego, CA 92103-3122 - Phone
- (858) 554-1212
- Fax
- (858) 430-3146
- NPI assigned
- Jun 19, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Value Based Long Term Care B PC
Nebraska House Call Physicians PC
Practice addresses (Care Compare)
3900 Pine Lake Rd
Suite 5
Lincoln, NE 68516-5489
Phone (402) 730-6870
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.17 of 100
- Quality
- 100
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NE, CA, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150818005939 | NE | Practitioner - Nurse Practitioner | 8022323195 | Reassigns benefits to 3 organizations |
| I20180309002328 | CA | Practitioner - Nurse Practitioner | 8022323195 | Reassigns benefits to 1 organization |
| I20220222002545 | TX | Practitioner - Nurse Practitioner | 8022323195 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95005125 | CA | MD | Nurse Practitioner |
Practice roles (7 of 8)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nebraska House Call Physicians, P.C. | Current |
Accepting new patients | |
| Advanced Medical Imaging, LLC | Current |
Accepting new patients | |
| Monica Perlman MD Inc. | Current |
Accepting new patients | |
| Value Based Long Term Care B PC | Current |
Accepting new patients | |
| Regents of the University of California | Past | Accepting new patients | |
| UC San Diego Health - Rancho Family Medical Group | Past | Accepting new patients | |
| Lightbridge Hospice, LLC | Past |
Accepting new patients |
Locations
9850 Genesee Ave
Ste 320
La Jolla, CA 92037
Phone (858) 864-9800
3737 Moraga Ave
Ste B103
San Diego, CA 92117
Phone (858) 799-0855
3900 5th Ave
Ste 110
San Diego, CA 92103
Phone (619) 291-5474
7601 Pioneers Blvd
Lincoln, NE 68506
Phone (402) 484-4475
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95005125 | CA | Yes |
Addresses
Primary practice location
3900 Fifth Ave Ste 110
San Diego, CA 92103-3122
Mailing address
2030 S Ditmar St
Oceanside, CA 92054-6526
Phone (402) 613-3916
Other names
- Meagan Goodman
Other providers in San Diego, CA
- Anneliese Petitt
- Angela Petkofsky
- Patrick Petprasert
- Brent A Petre
- Yasmin Petree
- Josephine Finneran Petrich
- Charles R. Petrie I
- Kristen M Petrie
- Michelle Marie Petrie
- Rachel Cyan Petrie
All providers in San Diego, CA · Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.