NPIMap

Organization Active NPI

Tatyana Petrosova, MD PC

  • Nephrology Physician
  • Saint Louis, MO
National Provider Identifier
1700026515
Registry record updated Jul 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
TATYANA PETROSOVA, MD PC
Practice address
10420 Old Olive Street Rd Ste 305
Saint Louis, MO 63141-5914
Phone
(314) 797-7074
Fax
(314) 227-5505
NPI assigned
Mar 6, 2009
Last updated
Jul 31, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2026

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

Authorized official

Name
Tatyana Petrosova, MDNPI 1023089562
Title
Owner
Phone
(314) 221-5363

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

10420 Old Olive Street Rd Ste 305
Saint Louis, MO 63141-5914

Mailing address

PO Box 653
Chesterfield, MO 63006-0653
Phone (314) 797-7074

Other practice location 1

10 Hospital Dr Fl 3
Saint Peters, MO 63376-1659
Phone (636) 317-4000

Other practice location 2

330 1st Capitol Dr Ste 240
Saint Charles, MO 63301-2846
Phone (636) 443-2440

Other practice location 3

1021 Wentzville Pkwy
Wentzville, MO 63385-3437
Phone (636) 332-3390

Other identifiers 1

IdentifierTypeStateIssuer
504381203MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100130000071 MO Part B Supplier - Clinic/Group Practice 4082757034 Receives reassigned benefits from 3 practitioners
Practice locations: Wentzville, MO; University City, MO; Ferguson, MO; Saint Louis, MO; Saint Charles, MO; O Fallon, MO; Lake St Louis, MO; Lake Saint Louis, MO…

National Provider Directory

National Provider Directory

Locations

13119 New Halls Ferry Rd
Florissant, MO 63033
Phone (314) 383-3252

2655 Muegge Rd
Ste 102
Saint Charles, MO 63303
Phone (636) 447-2490

10420 Old Olive Street Rd
Ste 305
Saint Louis, MO 63141
Phone (314) 797-7074

4145 Union Rd
Saint Louis, MO 63129
Phone (314) 894-1851

555 N New Ballas Rd
Saint Louis, MO 63141
Phone (314) 432-4999

10 Hospital Dr
Ste 3
Saint Peters, MO 63376

300 First Executive Ave
Saint Peters, MO 63376

9 Lincoln Ctr
Ste A
Troy, MO 63379
Phone (636) 462-4910

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785456000000",
    "number": "1700026515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 653",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630060653",
            "telephone_number": "314-797-7074",
            "fax_number": "314-227-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10420 OLD OLIVE STREET RD STE 305",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415914",
            "telephone_number": "314-797-7074",
            "fax_number": "314-227-5505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Hospital Dr Fl 3",
            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633761659",
            "country_code": "US",
            "telephone_number": "636-317-4000",
            "fax_number": "314-227-5505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "330 1st Capitol Dr Ste 240",
            "address_purpose": "LOCATION",
            "city": "Saint Charles",
            "state": "MO",
            "postal_code": "633012846",
            "country_code": "US",
            "telephone_number": "636-443-2440",
            "fax_number": "314-227-5505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1021 Wentzville Pkwy",
            "address_purpose": "LOCATION",
            "city": "Wentzville",
            "state": "MO",
            "postal_code": "633853437",
            "country_code": "US",
            "telephone_number": "636-332-3390",
            "fax_number": "314-227-5505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TATYANA PETROSOVA, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-06",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A",
        "authorized_official_last_name": "PETROSOVA",
        "authorized_official_first_name": "TATYANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-221-5363",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504381203",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.