Individual provider Active NPI

Jekaterina Tretyakov, M.D.

  • Internal Medicine Physician
  • Easton, PA
National Provider Identifier
1699972497
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MT185722 Issued in PA
Practice address
250 S 21St St
Easton, PA 18042-3851
Phone
(610) 250-4000
NPI assigned
Jun 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT185722 PA Primary

Addresses

Primary practice location

250 S 21St St
Easton, PA 18042-3851

Mailing address

1943 Pinehurst CT Apt G
Allentown, PA 18109-3293
Phone (610) 868-5778

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, MD2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20081103000309 PA Practitioner - HospitalistPractitioner - Internal Medicine 2365501558 Reassigns benefits to 1 organization
I20200109002071 MD Practitioner - Internal Medicine 2365501558 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

2001 Medical Pkwy
Annapolis, MD 21401-3280
Phone (443) 481-1000

Hospital & facility affiliations

  • Luminis Health Anne Arundel Medical Center, Inc Hospital, Annapolis, MD, CCN 210023

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT185722PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC Internal Medicine CurrentSince Dec 8, 2019 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Dec 8, 2019 Accepting new patients
Apogee Medical Group of Pennsylvania PC Internal Medicine CurrentSince Apr 1, 2008 Accepting new patients
Apogee Medical Group of Pennsylvania PC Internal Medicine CurrentSince Apr 1, 2008 Accepting new patients
Luminis Health Medical Group, LLC Current Accepting new patients
Luminis Health Anne Arundel Medical Center, Inc. Past Accepting new patients

Locations

15059 N Scottsdale Rd
Ste 600
Scottsdale, AZ 85254
Phone (602) 778-3601

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

2001 Medical Pkwy
Annapolis, MD 21401
Phone (410) 280-5601

250 S 21st St
Easton, PA 18042
Phone (610) 250-4300

1086 Franklin St
Johnstown, PA 15905
Phone (610) 250-4540

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699972497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1943 PINEHURST CT APT G",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181093293",
            "telephone_number": "610-868-5778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S 21ST ST",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180423851",
            "telephone_number": "610-250-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRETYAKOV",
        "first_name": "JEKATERINA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT185722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Easton, PA

Sources for this page

Verify at the official NPI Registry.