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DR. ANDREW DAVID MAMALIS MD
NPI 1023350402
Student in an Organized Health Care Education/Training Program in Modesto, CA

Active since March 22, 2013PECOS EnrolledAccepts Medicare Assignment
4125 BANGS AVE, MODESTO, CA 95356(209) 735-5510(209) 557-1614 Get Directions Write a Review

NPPES record last updated: March 5, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 5, 2024, Jan 6, 2022, Oct 18, 2018 and 2 more (5 updates tracked since 2017).

About Dr. Andrew David Mamalis Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ANDREW DAVID MAMALIS MD (NPI 1023350402) is an individual student in an organized health care education/training program in Modesto, California and active in the NPI registry since March 2013. He is enrolled in Medicare PECOS and is a graduate of University Of California, Davis School Of Medicine (2016).

NPPES Registry Identity

NPI1023350402
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. ANDREW DAVID MAMALISCredential: MD
Location Address4125 BANGS AVEModesto, CA 95356-8713
Mailing AddressSuny Downstate Medical Center, 450 Clarkson Avenue, Box 46Brooklyn, NY 11203 · (718) 270-1229 · Fax (727) 466-4918
Phone(209) 735-5510
Fax(209) 557-1614
Sole ProprietorNo
Medical School CMSUniversity Of California, Davis School Of MedicineGraduated 2016
Enumeration DateMarch 22, 2013
Last NPPES UpdateMarch 5, 20245 updates tracked since enumeration
NPPES CertifiedMarch 5, 2024
✔ NPI 1023350402 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4125 BANGS AVE, Modesto, CA 95356
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Andrew David Mamalis Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7113339755
PECOS Enrollment IDI20201223001578
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KURT DAYNE BAKER PH.D.
Psychologist (Clinical)
4125 BANGS AVE
MODESTO, CA 95356
Stanislaus County (209) 557-2300
MS. LISA TEIXEIRA
Social Worker (Clinical)
4125 BANGS AVE
MODESTO, CA 95356
Stanislaus County (209) 557-2314
NICOLE RENEE DAVIS-MARENCO FNP
Nurse Practitioner
4125 BANGS AVE
MODESTO, CA 95356
Stanislaus County (209) 735-5510
DR. MARY JESSIE SUMITHRA M.D
Pediatrics
4125 BANGS AVE
MODESTO, CA 95356
Stanislaus County (209) 557-1630
MARIA MARISSA DE LEON LIWAG MD
Pediatrics
4125 BANGS AVE
MODESTO, CA 95356
Stanislaus County (209) 551-3174
DR. BARBARA MARIE TODD PHD, MSCP
Psychologist (Clinical)
4125 BANGS AVE, DEPARTMENT OF PEDIATRICS, KAISER PERMANENTE
MODESTO, CA 95356
Stanislaus County (209) 557-1643
ANA LUISA CALLENDER LMFT
Counselor (Mental Health)
4125 BANGS AVE
MODESTO, CA 95356
Stanislaus County (209) 557-2309
SUSANA ANGELICA MILLAN
Social Worker (Clinical)
4125 BANGS AVE
MODESTO, CA 95356
Stanislaus County (209) 557-2363

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Andrew Mamalis's NPI number?

The NPI number for Andrew Mamalis is 1023350402. It was assigned to this individual provider in the NPPES registry on March 22, 2013.

Where is Andrew Mamalis located?

Andrew Mamalis practices at 4125 Bangs Ave, Modesto, CA 95356. The listed phone number is (209) 735-5510.

What is Andrew Mamalis's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Andrew Mamalis enrolled in Medicare?

Yes. Andrew Mamalis is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Andrew Mamalis was last updated on March 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.