NPIMap

Individual provider Active NPI

Demetra Serena Stamm, M.D.

  • General Practice Physician
  • San Mateo, CA
National Provider Identifier
1396906269
Registry record updated Jan 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A110149 Issued in CA
Practice address
222 W 39TH Ave
San Mateo, CA 94403-4364
Phone
(916) 955-2809
NPI assigned
Jun 23, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A110149 CA Primary

Addresses

Primary practice location

222 W 39TH Ave
San Mateo, CA 94403-4364

Mailing address

222 West 39TH Avenue
San Mateo County Behavioral Health and Recovery Service
San Mateo, CA 94403
Phone (916) 955-2809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20170105001626 CA Practitioner - Psychiatry 5496036469 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of North Carolina at Chapel Hill School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of San MateoGroup PAC ID 9032023171, shared by 15 NPIs, 316 clinicians

Practice addresses (Care Compare)

22 W 39TH Ave
Hos316Ms
San Mateo, CA 94403-4364

222 W 39TH Ave
San Mateo, CA 94403-4364

2710 Middlefield Rd
Redwood City, CA 94063-3404
Phone (650) 573-2222

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A110149CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Mateo CurrentSince Aug 15, 2017 Accepting new patients
San Mateo County CurrentSince Nov 27, 2016 Accepting new patients
County of San Mateo Current Accepting new patients
County of San Mateo Current Accepting new patients
County of San Mateo CurrentSince Nov 27, 2016 Accepting new patients

Locations

375 89th St
Daly City, CA 94015
Phone (650) 301-8650

802 Brewster Ave
Redwood City, CA 94063
Phone (650) 363-4111

222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222

1950 Alameda de las Pulgas
San Mateo, CA 94403
Phone (650) 573-3571

Interoperability endpoints

  • Direct secure messaging: dstamm19127@smch.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483488000000",
    "number": "1396906269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 WEST 39TH AVENUE",
            "address_2": "SAN MATEO COUNTY BEHAVIORAL HEALTH AND RECOVERY SERVICE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "94403",
            "telephone_number": "916-955-2809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W 39TH AVE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944034364",
            "telephone_number": "916-955-2809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAMM",
        "first_name": "DEMETRA",
        "middle_name": "SERENA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2017-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A110149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

Verify at the official NPI Registry.