Evaggelos Gary Mitrevolis, MD

Primary specialty

Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X

License

C164635 Issued in CA

Practice address

24552 Pacific Park Dr
Aliso Viejo, CA 92656-3055

Phone

(949) 446-0099

Fax

(949) 606-9297

NPI assigned

Jun 26, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• 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.

• Wentworth Douglass Physician Corporation

  • Magnetic Resonance Imaging Radiologic Technologist
  • Dover, NH
  • NPI 1447352430

  Hospitalist

  Medicare reassignment NPD
• Wentworth Douglass Physician Corporation

  • Diagnostic Radiology Physician
  • Somersworth, NH
  • NPI 1295326494
  NPD
• Laguna Treatment Hospital, LLC

  • Special Hospital
  • Aliso Viejo, CA
  • NPI 1063860534
  NPD (past)

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

{
    "created_epoch": "1277510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1154632990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 FIREFLY",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926188886",
            "telephone_number": "949-680-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24552 PACIFIC PARK DR",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563055",
            "telephone_number": "949-446-0099",
            "fax_number": "949-606-9297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITREVOLIS",
        "first_name": "EVAGGELOS",
        "middle_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-26",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C164635",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "CA",
            "license": "C164635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Mihalick
• Angela Rose Miller, D.O.
• Judith Ann Miller
• Timothy Robert Miller, M.D.
• Desiree Ann Mills, FNP-C
• Sonya Mitrovich, M.D.
• Saeideh Modjaby
• Ryann Monteiro
• Jennifer Kay Mooney, REGISTERED NURSE
• Gustavo a. Moreno Omana, MS

• Addiction Medicine (Preventive Medicine) Physician in Aliso Viejo, CA
• Providers in Aliso Viejo, CA by specialty
• Addiction Medicine (Preventive Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.