GREGORY AVETISOV (DO) – Internal Medicine Physician, NPI 1679917280
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,034 GENERAL PRACTICE in CA
Provider Addresses for GREGORY AVETISOV (DO)
PO BOX 1950
LAKEPORT, CA 954531950
Phone: (707) 263-8383
Fax: (707) 263-5019
Type: Mailing
925 BEVINS COURT
LAKEPORT, CA 954539754
Phone: (707) 263-8383
Fax: (707) 263-5019
Type: Location
721 COLORADO AVE STE 100
STUART, FL 349943017
Phone: (772) 888-2545
Type: Mailing
5700 STIRLING RD STE 100
HOLLYWOOD, FL 330211522
Phone: (277) 313-4764
Fax: (832) 804-8813
Type: Location
PO BOX 939
ANGELS CAMP, CA 952220939
Phone:
Type: Mailing
2641 MILLER RUN LN
LINCOLN, CA 956487545
Phone: (209) 754-6262
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 15 Open Payments records for all available years, with a total value of $304.
Total Amount is formed as General ($304) + Research ($0) + Ownership ($0) = $304.
Last reported payment date: 2024-10-25 • Largest payer in this snapshot: Lilly USA, LLC ($51).
Total Amount
$304
General + Research + Ownership
Payments
15
Total payment records
General Amount
$304
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-25
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2026-01-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 4 Medicare enrollment records; no due dates published yet.
Enrollment records
4
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20201027000040 | I | General Practice | FL | TBD |
| I20221207000333 | I | General Practice | OK | TBD |
| I20240716004349 | I | General Practice | CA | TBD |
| I20260108001909 | I | General Practice | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 154 | 111 | $0 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 43 | 13 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 33 | 33 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 25 | 23 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 14 | 14 | $0 |
Insurance plans in this area (ZIP 95453)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Marriage And Family Therapist | CA | |
| Family Practice | CA | |
| Physical Medicine And Rehabilitation | CO | |
| Marriage And Family Therapist | CA | |
| Family Practice | CA | |
| Anesthesiology, Pain Management | CA | |
| O P H T H A L M O L O G Y | IA | |
| Clinical Social Worker | MD | |
| - | CA | |
| Clinical Social Worker | CA |
Reviews
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