NPIMap

Organization Active NPI

Stanley K Mathis DPM Inc

  • Podiatrist
  • San Clemente, CA
National Provider Identifier
1649737651
Registry record updated May 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
STANLEY K MATHIS DPM INC
Practice address
211 Avenida Barcelona
San Clemente, CA 92672-5469
Phone
(949) 412-8445
Fax
(949) 218-0022
NPI assigned
Feb 26, 2019
Last updated
May 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2019

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

Authorized official

Name
Dr. Stanley Keith Mathis, DPMNPI 1871516922
Title
President
Phone
(949) 412-8445

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X Primary

Addresses

Primary practice location

211 Avenida Barcelona
San Clemente, CA 92672-5469

Mailing address

211 Avenida Barcelona
San Clemente, CA 92672-5469
Phone (949) 412-8445

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190802002564 CA Part B Supplier - Clinic/Group Practice 7416284138 Receives reassigned benefits from 9 practitioners
Practice locations: Santa Ana, CA; Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

1325 N Anaheim Blvd
Anaheim, CA 92801
Phone (657) 242-4381

1700 E Cesar E Chavez Ave
Ste 3100
Los Angeles, CA 90033
Phone (323) 263-9779

2740 S Bristol St
Ste 216
Santa Ana, CA 92704
Phone (714) 540-1924

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558656000000",
    "number": "1649737651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 AVENIDA BARCELONA",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926725469",
            "telephone_number": "949-412-8445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 AVENIDA BARCELONA",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926725469",
            "telephone_number": "949-412-8445",
            "fax_number": "949-218-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANLEY K MATHIS DPM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-26",
        "last_updated": "2019-05-24",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-412-8445",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.