Individual provider Active NPI

Theodore Steve Stamatakos, M.D.

  • Urology Physician
  • Keene, NH
National Provider Identifier
1720007099
Registry record updated Jun 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
EL09256 Issued in NH
Practice address
590 Court St
Keene, NH 03431-1719
Phone
(603) 354-5400
Fax
(603) 354-5400
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X LT4309 NH
Urology Physician 208800000X 200000981 NC
Urology Physician 208800000X EL09256 NH Primary

Addresses

Primary practice location

590 Court St
Keene, NH 03431-1719

Mailing address

590 Court St
Keene, NH 03431-1719
Phone (603) 354-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC, NH3 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

Enrollment IDStateProvider typePAC IDDetails
I20060505000726 NC Practitioner - UrologyPractitioner - Other (Physician) 3072524057 Reassigns benefits to 1 organization
I20071019000047 SC Practitioner - Urology 3072524057 Reassigns benefits to 1 organization
I20220317002354 NH Practitioner - Urology 3072524057 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
New York Medical College, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scotland Memorial Hospital, IncGroup PAC ID 0648208504, 259 clinicians

Practice addresses (Care Compare)

500 Lauchwood Dr
Laurinburg, NC 28352-5501
Phone (910) 610-4172

Hospital & facility affiliations

  • Scotland Memorial Hospital Hospital, Laurinburg, NC, CCN 340008

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12107SCMDPharmacist
LT4309NHMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cheshire Medical Center CurrentSince Mar 7, 2022 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Mar 7, 2022 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Mar 7, 2022 Accepting new patients
Cheshire Medical Center Current Accepting new patients
Providence Urology, PLLC Specialist PastSince Jun 1, 2009 Accepting new patients

Locations

580 Court St
Keene, NH 03431
Phone (603) 354-5454

590 Court St
Keene, NH 03431
Phone (603) 354-5454

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

Interoperability endpoints

  • Direct secure messaging: tstamatakos537587@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 7

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 1

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1720007099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 COURT ST",
            "city": "KEENE",
            "state": "NH",
            "postal_code": "034311719",
            "telephone_number": "603-354-5400",
            "fax_number": "704-414-2860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 COURT ST",
            "city": "KEENE",
            "state": "NH",
            "postal_code": "034311719",
            "telephone_number": "603-354-5400",
            "fax_number": "603-354-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAMATAKOS",
        "first_name": "THEODORE",
        "middle_name": "STEVE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NH",
            "license": "LT4309",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "200000981",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NH",
            "license": "EL09256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keene, NH

Sources for this page

Verify at the official NPI Registry.