Gregory Avetisov, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

20A22510 Issued in CA

Practice address

2641 Miller Run LN
Lincoln, CA 95648-7545

Phone

(209) 754-6262

NPI assigned

Apr 25, 2013

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

Medicare fee-for-service enrollment

Enrolled in FL, OK, CA, TX4 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

Specialty

General Practice

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Amador Hospital Hospital, Jackson, CA, CCN 050014
• Sutter Lakeside Hospital Hospital, Lakeport, CA, CCN 051329

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations (25 of 29)

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: gregory.avetisov.1@9618.direct.athenahealth.com

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.

• Lake County Tribal Health Consortium Inc.

  • Federally Qualified Health Center (FQHC)
  • Lakeport, CA
  • NPI 1881697381

  CA

  Medicare reassignment NPD
• M a C T Health Board Incorporated

  • Federally Qualified Health Center (FQHC)
  • San Andreas, CA
  • NPI 1366519431

  TX

  Medicare reassignment NPD
• Adair County Health Center, Inc.

  • Medical Specialty Clinic/Center
  • Stilwell, OK
  • NPI 1972780765

  OK

  Medicare reassignment NPD
• Best Value Healthcare LLC

  • Internal Medicine Physician
  • Clearwater, FL
  • NPI 1790152015

  FL, Internal Medicine

  Medicare reassignment NPD
• Florida Medical Associates LLC

  • Primary Care Clinic/Center
  • Lady Lake, FL
  • NPI 1336153709

  FL

  Medicare reassignment NPD
• Florida Medical Specialists LLC

  • Hematology & Oncology Physician
  • Sarasota, FL
  • NPI 1750399598

  FL

  Medicare reassignment NPD
• Hospital Care Consultants, Inc

  • Emergency Medicine Physician
  • McAlester, OK
  • NPI 1912945635

  OK

  Medicare reassignment NPD
• Rural Health Care Incorporated

  • Federally Qualified Health Center (FQHC)
  • Palatka, FL
  • NPI 1871569061

  FL, Internal Medicine

  Medicare reassignment NPD
• Sunset Point Medical Associates Inc

  • Internal Medicine Physician
  • Palm Harbor, FL
  • NPI 1366641698

  Family Medicine, FL

  Medicare reassignment NPD
• VMD Primary Providers Central Florida PLLC

  • Family Medicine Physician
  • Saint Cloud, FL
  • NPI 1134738974

  Family Medicine, FL

  Medicare reassignment NPD
• Newman Memorial Hospital, Inc

  • Critical Access Hospital
  • Shattuck, OK
  • NPI 1083617807

  OK

  Medicare reassignment
• Lake County Tribal Health Southshore Clinic

  • Federally Qualified Health Center (FQHC)
  • Clearlake, CA
  • NPI 1063158038
  NPD

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

• Sutter Bay Hospitals

  • Critical Access Hospital
  • Lakeport, CA
  • NPI 1952634008

  Hospital

  Care Compare affiliation
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Jackson, CA
  • NPI 1447494323

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780272000000",
    "number": "1679917280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "952220939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2641 MILLER RUN LN",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956487545",
            "telephone_number": "209-754-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVETISOV",
        "first_name": "GREGORY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-25",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "17139",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "20A22510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angel'S Sunrise Villa Inc
• Tara Armstrong
• Kimberly Iliana Arocho
• James Arriaga
• Taylor Artley
• Luis Angel Avila Cruz
• Alicia Avila
• Kenia G Babchanik, DPT
• Mark Reyes Baello, PT
• Sureena Bains-Takher, PHARMD

• All providers in Lincoln, CA
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2026; 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.