Pavel Vaclav Petrik, MD

Primary specialty

Trauma Surgery PhysicianTaxonomy code 2086S0127X

License

G74861 Issued in CA

Practice address

44725 10TH St W Ste 120
Lancaster, CA 93534-3051

Phone

(661) 522-3256

Fax

(661) 948-2006

NPI assigned

Oct 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 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

Specialty

Thoracic SurgeryAlso: General Surgery

Education

University of California, San Diego School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Antelope Valley Hospital Hospital, Lancaster, CA, CCN 050056

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Pavel V Petrik Medical Corporation

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Lancaster, CA
  • NPI 1598247991
  Medicare reassignment Authorized official

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

• Antelope Valley Health Care District

  • General Acute Care Hospital
  • Lancaster, CA
  • NPI 1366419517
  Care Compare affiliation

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1417044868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8700",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935398700",
            "telephone_number": "661-522-3256",
            "fax_number": "661-948-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44725 10TH ST W STE 120",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935343051",
            "telephone_number": "661-522-3256",
            "fax_number": "661-948-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIK",
        "first_name": "PAVEL",
        "middle_name": "VACLAV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "G74861",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "CA",
            "license": "G74861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jammie Peterson
• Jeanice Peterson, LEP
• Lise Anne Peterson
• Paul Anthony Peterson
• Alexander Petricevic
• Peyman Kafri Dental Corporation
• Mark Cameron Pfost
• Quynh T Phan, OD
• Tuan Dinh Phan, MD
• Pharmacy Express Care

• Trauma Surgery Physician in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Trauma Surgery Physician in California

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