Roy Muljadi Soetikno, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

G76556 Issued in CA

Practice address

2490 Hospital Dr Ste 211
Mountain View, CA 94040-4125

Phone

(650) 492-3384

Fax

(650) 963-3535

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Gastroenterology

Education

University of Chicago, Pritzker School of Medicine, 1990

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Advanced Gi Endoscopy Inc

  • Gastroenterology Physician
  • Mountain View, CA
  • NPI 1437497096
  Medicare reassignment
• Ies Medical Group, Inc.

  • Gastroenterology Physician
  • San Francisco, CA
  • NPI 1720130263
  NPD (past)
• Stanford Health Care

  dba Stanford Medical Center A Trade Name for Stanford Health Care

  • General Acute Care Hospital
  • Stanford, CA
  • NPI 1437292927
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1922119916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 HOSPITAL DR STE 211",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940404125",
            "telephone_number": "650-492-3384",
            "fax_number": "650-963-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 HOSPITAL DR STE 211",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940404125",
            "telephone_number": "650-492-3384",
            "fax_number": "650-963-3535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3801 Miranda Ave # Gi111",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "943041207",
            "country_code": "US",
            "telephone_number": "650-849-0542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOETIKNO",
        "first_name": "ROY",
        "middle_name": "MULJADI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "G76556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Conja So-Rosillo, PHARMD
• Rosendo So-Rosillo, MD
• Naomi Amanda So, MD
• Eric Sobalvarro, RCP
• Faranak Sobhanipour
• Sharad J Sohoni, DDS, MMSC
• Anna Sokalska, MD, PHD
• Randi Sokoloff, LCSW
• Jessica Solano
• Solara Medical Group

• Gastroenterology Physician in Mountain View, CA
• Providers in Mountain View, CA by specialty
• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.