Polina Pavlova, FNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95009998 Issued in CA

Practice address

1730 Alpine Blvd Ste 205
Alpine, CA 91901-3878

Phone

(619) 326-4445

Fax

(619) 722-1721

NPI assigned

Oct 10, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, shared by 4 NPIs, 11,250 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaiser Foundation Hospital - San Diego Hospital, San Diego, CA, CCN 050515

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12903/brand/1/csg/1/fhir/r4

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  dba Target Clinic Medical Associates of Southern California

  • Health Maintenance Organization
  • San Diego, CA
  • NPI 1023425972
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Fontana, CA
  • NPI 1316463763
  NPD
• Mary Gessner-Peterson Medical Group, Inc

  dba California Mobile Physicians and Comprehensive Medicine

  • Internal Medicine Physician
  • Alpine, CA
  • NPI 1467709220
  NPD (past)
• Gessner Peterson House Calls Inc

  dba Utah Mobile Physicians

  • Internal Medicine Physician
  • Logan, UT
  • NPI 1982246047
  NPD (past)

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

• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital San Diego

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1013062769
  Care Compare affiliation

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

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1386119881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 CAMINITO EL RINCON UNIT 221",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303501",
            "telephone_number": "619-632-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 ALPINE BLVD STE 205",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919013878",
            "telephone_number": "619-326-4445",
            "fax_number": "619-722-1721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7060 Clairemont Mesa Blvd",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921111003",
            "country_code": "US",
            "telephone_number": "619-632-7915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3555 Caminito El Rincon Unit 221",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921303501",
            "country_code": "US",
            "telephone_number": "619-632-7915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAVLOVA",
        "first_name": "POLINA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-10",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95009998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF REGISTERED NURSING",
            "identifier": "822420",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF REGISTERED NURSING NP LICENSE",
            "identifier": "95009998",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rodolfo Orozco, DDS
• Kenneth Kaleoaloha Ortiz, M.D.
• Christine Marie Paden
• Maria Christina Parra, R.N.
• Krina Patel
• Graciela Peace, PT
• Joni Lynn Pearce, LMFT
• Jill Suzanne Pendleton, DPT
• Alyssa Louise Pesce
• Heather Pesicka

• Nurse Practitioner in Alpine, CA
• Providers in Alpine, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; 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.