Caroline Petrossian

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

G076448 Issued in CA

Practice address

1880 Century Park East Suite 711
Century City, CA 90067

Phone

(818) 568-4110

Fax

(424) 625-0010

NPI assigned

Apr 26, 2018

Sex

Female

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• County of San Diego

  • Public Health or Welfare Agency
  • San Diego, CA
  • NPI 1225255375

  Single Specialty

  Medicare reassignment NPD
• County of San Diego

  • Community/Behavioral Health Agency
  • San Diego, CA
  • NPI 1255744587

  Single Specialty

  NPD
• County of San Diego

  • Ambulance
  • San Diego, CA
  • NPI 1316685159
  NPD

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

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1396233185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 PALISADES DR",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902722844",
            "telephone_number": "818-568-4110",
            "fax_number": "424-625-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 CENTURY PARK EAST SUITE 711",
            "city": "CENTURY CITY",
            "state": "CA",
            "postal_code": "90067",
            "telephone_number": "818-568-4110",
            "fax_number": "424-625-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSSIAN",
        "first_name": "CAROLINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-26",
        "last_updated": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "G076448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "401 Bicentennial Way",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ryan S Murdoch
• Damon S Orlando, D.C.
• Carolyn A Perry, PA
• Frederick C Perry
• Rose R Perry
• Alan Rosenbach, M.D.
• Sulema B Ruiz
• Catherine Sanchez
• Jahi Garrett Smith, DC
• Steven S Galen MD, Inc

• Geriatric Medicine (Internal Medicine) Physician in Century City, CA
• Providers in Century City, CA by specialty
• Geriatric Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.