Demetrios K. Mavroidis, M.D.

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

25IA12362700 Issued in NJ

Practice address

65 W Jimmie Leeds Rd
Pomona, NJ 08240-9102

Phone

(609) 652-1000

NPI assigned

Jan 3, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV, AZ, NJ3 enrollments

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 3

Specialty

Cardiac Surgery

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atlanticare Physician Group PAGroup PAC ID 8527953660, 506 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Patient Care Home health agency, Egg Harbor Township, NJ, CCN 317072
• Atlanticare Regional Medical Center - City Campus Hospital, Atlantic City, NJ, CCN 310064

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dmavroidis12944@direct.umcsn.com

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.

• Atlanticare Physician Group PA

  • Clinic/Center
  • Egg Harbor Township, NJ
  • NPI 1093829608

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Nevada Heart and Vascular Center Resh LLP

  • Cardiovascular Disease Physician
  • Las Vegas, NV
  • NPI 1659387934
  Medicare reassignment NPD
• VHS Outpatient Clinics, Inc.

  • Multi-Specialty Clinic/Center
  • Goodyear, AZ
  • NPI 1912979964

  Family Medicine

  Medicare reassignment NPD
• Atlanticare Physician Group, PA

  • Urgent Care Clinic/Center
  • Galloway, NJ
  • NPI 1003820622
  NPD
• Atlanticare Regional Medical Center

  • Community/Retail Pharmacy
  • Atlantic City, NJ
  • NPI 1235677378
  NPD
• Atlanticare Regional Medical Center

  • Internal Medicine Physician
  • Atlantic City, NJ
  • NPI 1568663250

  Family Medicine

  NPD
• Nevada Heart and Vascular Center Resh LLP

  • Cardiac Rehabilitation Registered Nurse
  • Las Vegas, NV
  • NPI 1891482113
  NPD
• VHS Outpatient Clinics, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Scottsdale, AZ
  • NPI 1891302790
  NPD
• Atlanticare Physician Group

  • Primary Care Clinic/Center
  • Ventnor City, NJ
  • NPI 1194839910
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Atlanticare Regional Medical Center

  • General Acute Care Hospital
  • Pomona, NJ
  • NPI 1013919315
  Care Compare affiliation
• LHCG CXLV, LLC

  • Home Health Agency
  • Egg Harbor Township, NJ
  • NPI 1154884401
  Care Compare affiliation

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1184602914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 W JIMMIE LEEDS RD",
            "city": "POMONA",
            "state": "NJ",
            "postal_code": "082409102",
            "telephone_number": "609-652-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 W JIMMIE LEEDS RD",
            "city": "POMONA",
            "state": "NJ",
            "postal_code": "082409102",
            "telephone_number": "609-652-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVROIDIS",
        "first_name": "DEMETRIOS",
        "middle_name": "K.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NV",
            "license": "9145",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NJ",
            "license": "25IA12362700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002018224",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Mangino-Blanchard, CRNP
• Denise Marable
• Kristen Marsh
• Constance Martindale, LCSW
• Marion R Massimiano, APN
• Aniya S Mazyck
• Dana McCloskey, M.D.
• John Daymond McKee III, M.D.
• Taral Divyakant Mehta, MD
• Joseph Miessau, DMSC PA-C

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Pomona, NJ
• Providers in Pomona, NJ by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.