Dr Evaggelos Gary Mitrevolis, MD is a medicare enrolled "Preventive Medicine - Addiction Medicine" physician in Aliso Viejo, California. His current practice location is
24552 Pacific Park Dr, Aliso Viejo, California. You can reach out to his office (for appointments etc.) via phone at
(949) 446-0099.
Dr Evaggelos Gary Mitrevolis is licensed to practice in California (license number C164635) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1154632990.
Physician's Profile
| Full Name | Dr Evaggelos Gary Mitrevolis |
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| Gender | Male |
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| Speciality | Preventive Medicine - Addiction Medicine |
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| Location | 24552 Pacific Park Dr, Aliso Viejo, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1154632990
- Provider Enumeration Date: 06/26/2010
- Last Update Date: 04/08/2024
Medicare PECOS Information:
- PECOS PAC ID: 8224270871
- Enrollment ID: I20130809000424
Medical Identifiers
Medical identifiers for Dr Evaggelos Gary Mitrevolis such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1154632990 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207R00000X | Internal Medicine | C164635 (California) | Secondary |
| 2083A0300X | Preventive Medicine - Addiction Medicine | C164635 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Evaggelos Gary Mitrevolis allows following entities to bill medicare on his behalf.
| Entity Name | Wentworth Douglass Physician Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1447352430
PECOS PAC ID: 5496749848
Enrollment ID: O20040409000433 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Evaggelos Gary Mitrevolis is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Evaggelos Gary Mitrevolis, MD
174 Firefly,
Irvine, CA 92618-8886
Ph: (949) 680-7760 | Dr Evaggelos Gary Mitrevolis, MD
24552 Pacific Park Dr,
Aliso Viejo, CA 92656-3055
Ph: (949) 446-0099 |
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