Individual provider Active NPI

Yegor V Patrikeyev, PA-C, MS

  • Surgical Physician Assistant
  • Sacramento, CA
National Provider Identifier
1649239385
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA17742 Issued in CA
Practice address
2025 Morse Ave
Sacramento, CA 95825-2115
Phone
(916) 973-5275
NPI assigned
Mar 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA873 ME
Surgical Physician Assistant 363AS0400X PA17742 CA Primary

Addresses

Primary practice location

2025 Morse Ave
Sacramento, CA 95825-2115

Mailing address

6519 Sylvan Rd Apt 212
Citrus Heights, CA 95610-4485

Other identifiers 2

IdentifierTypeStateIssuer
048075OtherMEANTHM
431937099MedicaidME

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120118000137 CA Practitioner - Physician Assistant 2264486737 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA17742CAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc CurrentSince Oct 15, 2011 Accepting new patients
Permanente Medical Group, Inc CurrentSince Oct 15, 2011 Accepting new patients
Maine Orthopaedic Center, PA Past Accepting new patients

Locations

2025 Morse Ave
Sacramento, CA 95825

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1649239385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6519 SYLVAN RD APT 212",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956104485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 MORSE AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958252115",
            "telephone_number": "916-973-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRIKEYEV",
        "first_name": "YEGOR",
        "middle_name": "V",
        "name_prefix": "Mr.",
        "credential": "PA-C, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-21",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ME",
            "license": "PA873",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA17742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHM",
            "identifier": "048075",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "431937099",
            "state": "ME"
        }
    ],
    "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": "2025 Morse Ave",
            "city": "Sacramento",
            "state": "CA",
            "country_code": "US",
            "postal_code": "958252115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.