NPIMap

Individual provider Active NPI

Stefanos Pantagis, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Hackensack, NJ
National Provider Identifier
1235212879
Registry record updated Feb 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
MA64903 Issued in NJ
Practice address
810 Main St
Hackensack, NJ 07601-4847
Phone
(201) 633-7375
Fax
(201) 633-7361
NPI assigned
Oct 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MA64903 NJ
Geriatric Medicine (Family Medicine) Physician 207QG0300X MA64903 NJ Primary

Addresses

Primary practice location

810 Main St
Hackensack, NJ 07601-4847

Mailing address

164 Winthrop PL
Englewood, NJ 07631-3054
Phone (201) 633-7375

Other identifiers 1

IdentifierTypeStateIssuer
6818706MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20040223000286 NJ Practitioner - Geriatric MedicinePractitioner - Family Practice 2163318783 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Family Practice
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geriatrics and Longevity Treatment Specialist, PCGroup PAC ID 3072787308, 9 clinicians

Practice addresses (Care Compare)

164 Winthrop PL
Englewood, NJ 07631-3054

38 N Central Ave
Ramsey, NJ 07446-1808
Phone (201) 488-6728

810 Main St
Hackensack, NJ 07601-4847
Phone (201) 633-7375

Hospital & facility affiliations

  • Valley Home Care Inc. Home health agency, Paramus, NJ, CCN 317008
  • Amedisys Home Health Home health agency, Hackensack, NJ, CCN 317047
  • Adoration Home Health Home health agency, Clifton, NJ, CCN 317017
  • Life Source Services LLC Hospice, Oradell, NJ, CCN 311549
  • Homeside Hospice LLC Hospice, Cranford, NJ, CCN 311559
  • Amedisys Hospice Hospice, Hackensack, NJ, CCN 311510
  • Valley Hospital Hospital, Paramus, NJ, CCN 310012
  • Hackensack University Medical Center Hospital, Hackensack, NJ, CCN 310001
  • Englewood Hospital and Medical Center Hospital, Englewood, NJ, CCN 310045
  • Hackensack Meridian Health Pascack Valley Medical Hospital, Westwood, NJ, CCN 310130
  • Atlas Rehabilitation and Healthcare at Maywood Nursing home, Maywood, NJ, CCN 315386
  • Family of Caring at Park Ridge LLC Nursing home, Park Ridge, NJ, CCN 315438

Merit-based Incentive Payment System (MIPS)

Final score
94.94 of 100Reported as group
Quality
100
Improvement activities
40
Cost
56.48

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Geriatrics and Longevity Treatment Specialist, PC Geriatric Medicine CurrentSince Nov 1, 2011 Accepting new patients
Aspen Medical Associates, LLC Past Accepting new patients
120-124 Noyes Drive Operating Company LLC Past Accepting new patients
Maywood SNF Operations LLC Past Accepting new patients

Locations

810 Main St
Hackensack, NJ 07601
Phone (201) 488-6728

Interoperability endpoints

  • Direct secure messaging: spantagis190085@ahs.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Atlas Rehabilitation and Healthcare at MaywoodMaywood, NJ, CCN 315386 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 22, 2020
Dec 22, 2020
Journey Palliative Care & TransitionsOradell, NJ, CCN 311549 Hospice W-2 Managing Employee Apr 1, 2023

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391558400000",
    "number": "1235212879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 WINTHROP PL",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076313054",
            "telephone_number": "201-633-7375",
            "fax_number": "201-633-7361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076014847",
            "telephone_number": "201-633-7375",
            "fax_number": "201-633-7361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANTAGIS",
        "first_name": "STEFANOS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2014-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MA64903",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "MA64903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6818706",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.