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DR. EVAGGELOS GARY MITREVOLIS MD
NPI 1154632990
Preventive Medicine - Addiction Medicine in Aliso Viejo, CA

Active since June 26, 2010PECOS Enrolled
24552 PACIFIC PARK DR, ALISO VIEJO, CA 92656(949) 446-0099(949) 606-9297 Get Directions Write a Review

NPPES record last updated: April 8, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 8, 2024, Apr 2, 2024, Mar 29, 2018 (3 updates tracked since 2018).

About Dr. Evaggelos Gary Mitrevolis Md NPPES

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

DR. EVAGGELOS GARY MITREVOLIS MD (NPI 1154632990) is an individual addiction medicine provider in Aliso Viejo, California, licensed in California (C164635) and active in the NPI registry since June 2010. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1154632990
Entity TypeIndividualMale
Primary Taxonomy2083A0300X
Provider Legal NameDR. EVAGGELOS GARY MITREVOLISCredential: MD
Location Address24552 PACIFIC PARK DRAliso Viejo, CA 92656-3055
Mailing Address174 FireflyIrvine, CA 92618-8886 · (949) 680-7760
Phone(949) 446-0099
Fax(949) 606-9297
Sole ProprietorNo
Enumeration DateJune 26, 2010
Last NPPES UpdateApril 8, 20243 updates tracked since enumeration
NPPES CertifiedApril 8, 2024
✔ NPI 1154632990 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPreventive Medicine · Addiction MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2083A0300X
License✔ Licensed in CA · C164635
Definition
A physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction.
Also ListedInternal MedicineTaxonomy 207R00000X · License C164635 (CA)
24552 PACIFIC PARK DR, Aliso Viejo, CA 92656
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Evaggelos Gary Mitrevolis Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Evaggelos Mitrevolis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Wentworth Douglass Physician Corporation
2,590 mi
Diabetes Educator
10 MEMBERS WAY FL 5
Dover, NH 03820
  • Reassigned Medicare billing, New Hampshire enrollment
  • 559 clinicians in this Medicare group
NPI 1336751825 (603) 609-6800

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92656 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$142.39 typical visit price
range $62.96 – $187.60
Typical copayment $35.59 (range $15.74 – $46.90)
Most-billed visit code 99204
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 10

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

LAGUNA TREATMENT HOSPITAL, LLC
Special Hospital
24552 PACIFIC PARK DR
ALISO VIEJO, CA 92656
Orange County (949) 446-0090
YEN ANKER NP
Nurse Practitioner
24552 PACIFIC PARK DR
ALISO VIEJO, CA 92656
Orange County (949) 565-2377
LILIAN ROSE BALLENTOS GUMBAN-SALDANA NP
Nurse Practitioner (Psychiatric/Mental Health)
24552 PACIFIC PARK DR
ALISO VIEJO, CA 92656
Orange County (949) 446-0090
HANS-ON RECOVERY, PLLC
Internal Medicine (Addiction Medicine)
24552 PACIFIC PARK DR
ALISO VIEJO, CA 92656
Orange County (518) 413-1600
ASHLEY YUSAM PA-C
Physician Assistant
24552 PACIFIC PARK DR
ALISO VIEJO, CA 92656
Orange County (949) 565-2377
PRISM HEALTH INC.
Assisted Living Facility
24552 PACIFIC PARK DR, ELDERLY ASSISTED LIVING/MEMORY CARE-DIMENTIA
ALISO VIEJO, CA 92656
Orange County (949) 425-8300
HOLLY ANN OLALIA DNP, PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
24552 PACIFIC PARK DR
ALISO VIEJO, CA 92656
Orange County (949) 647-4618
CHRISTOPHER CUMMINS LMFT, LCADC, ACS
Marriage & Family Therapist
24552 PACIFIC PARK DR
ALISO VIEJO, CA 92656
Orange County (494) 460-0909

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 Evaggelos Mitrevolis's NPI number?

The NPI number for Evaggelos Mitrevolis is 1154632990. It was assigned to this individual provider in the NPPES registry on June 26, 2010.

Where is Evaggelos Mitrevolis located?

Evaggelos Mitrevolis practices at 24552 Pacific Park Dr, Aliso Viejo, CA 92656. The listed phone number is (949) 446-0099.

What is Evaggelos Mitrevolis's specialty?

The primary specialty registered for this NPI is Preventive Medicine, specializing in Addiction Medicine, with taxonomy code 2083A0300X.

Is Evaggelos Mitrevolis enrolled in Medicare?

Yes. Evaggelos Mitrevolis is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Evaggelos Mitrevolis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Evaggelos Mitrevolis reassigns Medicare benefits to Wentworth Douglass Physician Corporation (Dover, NH). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Evaggelos Mitrevolis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Evaggelos Mitrevolis was last updated on April 8, 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.