Individual provider Active NPI

Lyudmila Ivanovna Petruk, MD

  • Neurology Physician
  • Tacoma, WA
National Provider Identifier
1528154770
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD00046499 Issued in WA
Practice address
209 Martin Luther King Jr Way
Tacoma, WA 98405-4265
Phone
(253) 596-3410
NPI assigned
Oct 5, 2006
Last updated
Mar 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X MD27033 OR
Neurology Physician 2084N0400X 4215 WI
Neurology Physician 2084N0400X 21092 NV
Neurology Physician 2084N0400X MD00046499 WA Primary
Neurology Physician 2084N0400X 76532 MN

Addresses

Primary practice location

209 Martin Luther King Jr Way
Tacoma, WA 98405-4265

Mailing address

209 Martin Luther King Jr Way
Tacoma, WA 98405-4265
Phone (253) 596-3300

Other practice location 1

1608 S J St Fl 5
Tacoma, WA 98405-4930
Phone (253) 274-7505

Other practice location 2

535 Hospital Rd
New Richmond, WI 54017-1449
Phone (715) 243-3400

Other practice location 3

834 Sheridan St
Port Townsend, WA 98368-2443
Phone (360) 774-8125

Other identifiers 1

IdentifierTypeStateIssuer
MD27033OtherORMEDICAL LICENSE

Electronic endpoints 2

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)
Direct Messaging Address lpetruk891152@fhsce.catholichealth.net Direct Franciscan Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, NV, MN, WI4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20090617000646 WA Practitioner - Neurology 4587662549 Reassigns benefits to 6 organizations
I20210617000569 NV Practitioner - Neurology 4587662549 Reassigns benefits to 1 organization
I20240610003117 MN Practitioner - Neurology 4587662549 Reassigns benefits to 1 organization
I20240610003398 WI Practitioner - Neurology 4587662549 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Washington School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians
Amery Regional Medical Center IncGroup PAC ID 2769391960, 124 clinicians
Westfields Hospital IncGroup PAC ID 2264490960, 108 clinicians

Practice addresses (Care Compare)

1608 S J St
FL 5
Tacoma, WA 98405-4930
Phone (253) 274-7505

265 Griffin E St
Amery, WI 54001-1439
Phone (715) 268-8000

265 Griffin St E
Amery, WI 54001-1439
Phone (715) 268-8000

535 Hospital Rd
New Richmond, WI 54017-1449
Phone (715) 243-2600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
76532MNMDNeurology Physician
MD00046499WAMDNeurology Physician
4215WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carson Tahoe Physician Clinics CurrentSince Jun 14, 2021 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Jul 8, 2024 Accepting new patients
Franciscan Medical Group CurrentSince Jan 20, 2025 Accepting new patients
CTH Physicians Clinic Current Accepting new patients
Franciscan Medical Group CurrentSince Jan 20, 2025 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Dec 27, 2025 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince May 6, 2009 Accepting new patients
Multicare Health System CurrentSince Mar 2, 2022 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince May 6, 2009 Accepting new patients
Group Health, Inc. CurrentSince Jul 8, 2024 Accepting new patients
Westfields Hospital, Inc CurrentSince Jul 8, 2024 Accepting new patients
Multicare Health System Current Accepting new patients
Virginia Mason Medical Center CurrentSince Jul 20, 2023 Accepting new patients
Multicare Health System CurrentSince Mar 2, 2022 Accepting new patients
Group Health, Inc. CurrentSince Jul 8, 2024 Accepting new patients
Virginia Mason Medical Center Current Accepting new patients
Virginia Mason Medical Center CurrentSince Jul 20, 2023 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Jul 8, 2024 Accepting new patients
Westfields Hospital, Inc. CurrentSince Jul 8, 2024 Accepting new patients
Group Health, Inc. CurrentSince Jul 8, 2024 Accepting new patients
Westfields Hospital, Inc. Past Accepting new patients
Amery Regional Medical Center, Inc. Past Accepting new patients
West Physician Services LLC Past Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

1500 Curve Crest Blvd W
Stillwater, MN 55082

1470 Medical Pkwy
Ste 160
Carson City, NV 89703

1600 Medical Pkwy
Carson City, NV 89703
Phone (775) 220-9149

2874 N Carson St
Ste 200
Carson City, NV 89706
Phone (775) 283-3220

570 S Maine St
Fallon, NV 89406
Phone (775) 423-9511

380 Winslow Way E
Bainbridge Island, WA 98110
Phone (206) 842-5632

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

1100 9th Ave
Seattle, WA 98101
Phone (206) 223-6980

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

925 Seneca St
Seattle, WA 98101
Phone (206) 341-0860

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

209 Martin Luther King Jr Way
Tacoma, WA 98405
Phone (253) 596-3300

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

265 Griffin St E
Amery, WI 54001
Phone (715) 268-0301

411 Stageline Rd
#200
Hudson, WI 54016
Phone (715) 531-6700

535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013

744 E Louisiana St
St Croix Fls, WI 54024
Phone (651) 772-6251

Interoperability endpoints

  • Direct secure messaging: lpetruk891152@fhsce.catholichealth.net

Organizations & group practices 25

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 25

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1528154770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 MARTIN LUTHER KING JR WAY",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054265",
            "telephone_number": "253-596-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 MARTIN LUTHER KING JR WAY",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054265",
            "telephone_number": "253-596-3410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1608 S J St Fl 5",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984054930",
            "country_code": "US",
            "telephone_number": "253-274-7505",
            "fax_number": "253-985-2853",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "535 Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "New Richmond",
            "state": "WI",
            "postal_code": "540171449",
            "country_code": "US",
            "telephone_number": "715-243-3400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "834 Sheridan St",
            "address_purpose": "LOCATION",
            "city": "Port Townsend",
            "state": "WA",
            "postal_code": "983682443",
            "country_code": "US",
            "telephone_number": "360-774-8125",
            "fax_number": "360-774-8127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRUK",
        "first_name": "LYUDMILA",
        "middle_name": "IVANOVNA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "OR",
            "license": "MD27033",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "4215",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NV",
            "license": "21092",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD00046499",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "76532",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MD27033",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "209 Martin Luther King Jr Way",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984054265",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lpetruk891152@fhsce.catholichealth.net",
            "affiliation": "Y",
            "affiliationName": "Franciscan Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1608 S J St Fl 5",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984054930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.