NPIMap

Individual provider Active NPI

Stan Mathioulakis, MD

  • Internal Medicine Physician
  • Duarte, CA
National Provider Identifier
1912080847
Registry record updated Feb 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A85470 Issued in CA
Practice address
931 Buena Vista St
Suite 102
Duarte, CA 91010-1712
Phone
(626) 358-3204
Fax
(626) 358-9748
NPI assigned
Oct 23, 2006
Last updated
Feb 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A85470 CA Primary

Addresses

Primary practice location

931 Buena Vista St
Suite 102
Duarte, CA 91010-1712

Mailing address

931 Buena Vista St
Suite 102
Duarte, CA 91010-1712
Phone (626) 358-3204

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
I20040922001208 CA Practitioner - Internal Medicine 2961470315 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

931 Buena Vista St
Suite 102
Duarte, CA 91010-1780
Phone (626) 358-3204

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A85470CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pulmonary & Hospitalist Associates Inc CurrentSince Nov 8, 2025 Accepting new patients
American Family Medical Providers Inc CurrentSince Oct 1, 2005 Accepting new patients
Jason K Boutros M D Inc Internal Medicine PastSince Aug 28, 1996 Accepting new patients
Usc Arcadia Hospital Past Accepting new patients
Pasadena Hospital Association, LTD. Past Accepting new patients
Ahmc Greater El Monte Comm Hosp LLC Past Accepting new patients

Locations

931 Buena Vista St
Ste 102
Duarte, CA 91010
Phone (626) 303-2525

10 Congress St
Ste 506
Pasadena, CA 91105
Phone (626) 403-0348

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1912080847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 BUENA VISTA ST",
            "address_2": "SUITE 102",
            "city": "DUARTE",
            "state": "CA",
            "postal_code": "910101712",
            "telephone_number": "626-358-3204",
            "fax_number": "626-358-9748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 BUENA VISTA ST",
            "address_2": "SUITE 102",
            "city": "DUARTE",
            "state": "CA",
            "postal_code": "910101712",
            "telephone_number": "626-358-3204",
            "fax_number": "626-358-9748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIOULAKIS",
        "first_name": "STAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A85470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duarte, CA

Sources for this page

Verify at the official NPI Registry.