NPIMap

Individual provider Active NPI

Larissa Stathakes, P.A.

  • Physician Assistant
  • Trenton, NJ
National Provider Identifier
1992935100
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00221400 Issued in NJ
Practice address
750 Brunswick Ave
Helene Fuld Medical Center
Trenton, NJ 08638-4143
Phone
(800) 345-0064
Fax
(973) 251-1109
NPI assigned
Jul 22, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 25MP00221400 NJ Primary

Addresses

Primary practice location

750 Brunswick Ave
Helene Fuld Medical Center
Trenton, NJ 08638-4143

Mailing address

PO Box 747
Livingston, NJ 07039-0747
Phone (800) 345-0064

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20090911000350 NJ Practitioner - Physician Assistant 9638224884 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cooper Urgent Care PCGroup PAC ID 2860644234, 57 clinicians

Practice addresses (Care Compare)

2001 Route 70 E
Cherry Hill, NJ 08003-1200
Phone (856) 874-0194

Merit-based Incentive Payment System (MIPS)

Final score
91.47 of 100Reported as group
Quality
93.22
Promoting interoperability
99
Improvement activities
40
Cost
79.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
017389NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
South Jersey Emergency Physicians, PA Past Accepting new patients
TBHC Emergency Medicine PC Past Accepting new patients
Rahway Emergency Medical Associates, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lstathakes119035@direct.cooperhealth.edu

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1992935100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 747",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070390747",
            "telephone_number": "800-345-0064",
            "fax_number": "973-251-1109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 BRUNSWICK AVE",
            "address_2": "HELENE FULD MEDICAL CENTER",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086384143",
            "telephone_number": "800-345-0064",
            "fax_number": "973-251-1109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATHAKES",
        "first_name": "LARISSA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-22",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00221400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trenton, NJ

Sources for this page

Verify at the official NPI Registry.