DR. MARY JEAN SCOURBOUTAKOS MD, PHD
NPI 1184310104
Family Medicine in Bronx, NY

Q: What is Mary Scourboutakos's NPI number?

The NPI number for Mary Scourboutakos is 1184310104. It was assigned to this individual provider in the NPPES registry on April 13, 2023.

Q: What is Mary Scourboutakos's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since April 13, 2023PECOS EnrolledAccepts Medicare Assignment

731 WHITE PLAINS RD, BRONX, NY 10473(718) 589-8775(845) 633-5766 Get Directions Write a Review

NPPES record last updated: July 23, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Mary Jean Scourboutakos Md, Phd NPPES

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

DR. MARY JEAN SCOURBOUTAKOS MD, PHD (NPI 1184310104) is an individual family medicine provider in Bronx, New York, licensed in New York (335325) and active in the NPI registry since April 2023. She is enrolled in Medicare PECOS and is a graduate of University Of Toronto, Faculty Of Medicine (2021).

NPPES Registry Identity

NPI1184310104

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameDR. MARY JEAN SCOURBOUTAKOSCredential: MD, PHD

Location Address731 WHITE PLAINS RDBronx, NY 10473-2631

Mailing Address107 Homestead Rd.Toronto, ONTARIO M1E 3S1

Phone(718) 589-8775

Fax(845) 633-5766

Sole ProprietorNo

Medical School CMSUniversity Of Toronto, Faculty Of MedicineGraduated 2021

Enumeration DateApril 13, 2023

Last NPPES UpdateJuly 23, 2025

NPPES CertifiedJuly 23, 2025

✔ NPI 1184310104 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in NY · 335325

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

731 WHITE PLAINS RD, Bronx, NY 10473

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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. Mary Jean Scourboutakos Md, Phd 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 ID1153829155

PECOS Enrollment IDI20250808003259

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10473 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

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

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 20

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

W.B. DIAGNOSTIC IMAGING P.C.

Radiology (Diagnostic Radiology)