NPIMap

Individual provider Active NPI

Andrey Petrikovets, M.D.

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Los Angeles, CA
National Provider Identifier
1922307123
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
A127810 Issued in CA
Practice address
3312 Glendale Blvd
Los Angeles, CA 90039-1813
Phone
(888) 487-6496
Fax
(323) 250-1361
NPI assigned
Mar 28, 2011
Last updated
Dec 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X A127810 CA Primary

Addresses

Primary practice location

3312 Glendale Blvd
Los Angeles, CA 90039-1813

Mailing address

PO Box 39466
Los Angeles, CA 90039-0466
Phone (888) 487-6496

Other practice location 1

1513 S Grand Ave Ste 400
Los Angeles, CA 90015
Phone (213) 742-6400

Other names 1

  • Dr. Andre Petrikovets Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181010002640 CA Practitioner - Obstetrics/Gynecology 7517288913 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1513 S Grand Ave
Suite 400
Los Angeles, CA 90015-3075
Phone (213) 742-6400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A127810CAMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Andrey Petrikovets MD a Professional Corporation Urogynecology and Reconstructive Pelvic Surgery CurrentSince Sep 1, 2018 Accepting new patients
The Metrohealth System Current Accepting new patients
Dignity Health Past Accepting new patients
Dignity Community Care Past Accepting new patients
Good Samaritan Hospital, L.P. Past Accepting new patients
Pih Health Good Samaritan Hospital Past Accepting new patients
Tarzana Medical Center LLC Past Accepting new patients
Cha Hollywood Medical Center, LP Past Accepting new patients
The Good Samaritan Hospital of Lebanon, Pennsylvania Past Accepting new patients

Locations

222 W Eulalia St
Ste 211
Glendale, CA 91204
Phone (818) 502-4567

1513 S Grand Ave
Ste 400
Los Angeles, CA 90015
Phone (213) 742-5784

2500 Metrohealth Dr
Cleveland, OH 44109
Phone (216) 778-2348

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: apetrikovets103549@direct.metrohealth.org

Organizations & group practices 9

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.

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": "1301270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1922307123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39466",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900390466",
            "telephone_number": "888-487-6496",
            "fax_number": "323-250-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 GLENDALE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900391813",
            "telephone_number": "888-487-6496",
            "fax_number": "323-250-1361"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1513 S Grand Ave Ste 400",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90015",
            "country_code": "US",
            "telephone_number": "213-742-6400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRIKOVETS",
        "first_name": "ANDREY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-28",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "CA",
            "license": "A127810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDRE",
            "last_name": "PETRIKOVETS",
            "prefix": "DR.",
            "credential": "MD FACOG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.