NPIMap

Individual provider Active NPI

John Stathis, MD

  • Cardiovascular Disease Physician
  • Longmont, CO
National Provider Identifier
1902803174
Registry record updated Jan 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
39861 Issued in CO
Practice address
1925 W Mountain View Ave
Longmont, CO 80501-3128
Phone
(303) 776-1234
Fax
(720) 494-3107
NPI assigned
Jul 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 39861 CO Primary

Addresses

Primary practice location

1925 W Mountain View Ave
Longmont, CO 80501-3128

Mailing address

1925 W Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

Other identifiers 1

IdentifierTypeStateIssuer
45425019MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20100810001028 CO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1456485614 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

Hospital & facility affiliations

  • Longs Peak Hospital Hospital, Longmont, CO, CCN 060128
  • Medical Center of the Rockies Hospital, Loveland, CO, CCN 060119
  • University of Colorado Hospital Authority Hospital, Aurora, CO, CCN 060024

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39861COMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jan 1, 2015 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jan 1, 2015 Accepting new patients
Florida Institute of Health LTD LLLP Past Accepting new patients
FMC Cardiology Panel LLC Cardiovascular Disease Past Accepting new patients
University Hospital Ekg Readers Inc Cardiovascular Disease Past Accepting new patients
Ekg & Echo Readers Inc Cardiovascular Disease Past Accepting new patients

Locations

11820 Destination Dr
Broomfield, CO 80021
Phone (303) 460-6000

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

6600 Firestone Blvd
Firestone, CO 80504
Phone (303) 649-3450

1760 E Ken Pratt Blvd
Ste 405
Longmont, CO 80504
Phone (720) 718-5400

1760 E Ken Pratt Blvd
Ste 205
Longmont, CO 80504
Phone (720) 718-3930

1925 Mountain View Ave
Longmont, CO 80501
Phone (303) 776-1234

1750 E Ken Pratt Blvd
Ste 205
Longmont, CO 80504

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Uchealth Broomfield HospitalBroomfield, CO, CCN 060129 Hospital Corporate Director Sep 1, 2020
Longs Peak HospitalLongmont, CO, CCN 060128 Hospital Corporate Director Jan 19, 2017
UchealthBroomfield, CO, CCN 06T129 Hospital Corporate Director Sep 1, 2020

Owned or controlled facilities with NPI records 3

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

Organizations & group practices 6

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 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1120348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420675200000",
    "number": "1902803174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 W MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013128",
            "telephone_number": "303-776-1234",
            "fax_number": "720-494-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 W MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013128",
            "telephone_number": "303-776-1234",
            "fax_number": "720-494-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATHIS",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-03",
        "last_updated": "2015-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CO",
            "license": "39861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45425019",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.