Demetrios Nectarios Mallios, MD

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

146158 Issued in CA

Practice address

1520 San Pablo St
Health Consultation Ceneter II, Suite 4300
Los Angeles, CA 90033-5310

Phone

(323) 442-5849

NPI assigned

Nov 27, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Usc Care Medical Group, Inc

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1902846306
  Medicare reassignment NPD
• Usc Care Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Pasadena, CA
  • NPI 1427937390
  NPD

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

{
    "created_epoch": "1480204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480204800000",
    "number": "1144763095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST",
            "address_2": "HEALTH CONSULTATION CENETER II, SUITE 4300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST",
            "address_2": "HEALTH CONSULTATION CENETER II, SUITE 4300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335310",
            "telephone_number": "323-442-5849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIOS",
        "first_name": "DEMETRIOS",
        "middle_name": "NECTARIOS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-27",
        "last_updated": "2016-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "146158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jon Mallen-St. Clair, M.D.
• Aviva Maller, OTR
• Mallett Chiropractic PC
• Chett Legrand Mallett, D.C.
• Christian Mallett, PH.D.
• Alejandra Mallorga Hernandez, MD
• Devin Mallory
• Fernando Mallory
• John David Mallory
• Lauren Michelle Mallory, M.S.

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.