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DR. ROY MULJADI SOETIKNO MD
NPI 1922119916
Internal Medicine - Gastroenterology in Mountain View, CA

Active since August 31, 2006PECOS Enrolled
2490 HOSPITAL DR STE 211, MOUNTAIN VIEW, CA 94040(650) 492-3384(650) 963-3535 Get Directions Write a Review

NPPES record last updated: April 14, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Roy Muljadi Soetikno Md NPPES

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

DR. ROY MULJADI SOETIKNO MD (NPI 1922119916) is an individual gastroenterology provider in Mountain View, California, licensed in California (G76556) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS, maintains a secondary practice location in Palo Alto, and is a graduate of University Of Chicago, Pritzker School Of Medicine (1990).

NPPES Registry Identity

NPI1922119916
Entity TypeIndividualMale
Primary Taxonomy207RG0100X
Provider Legal NameDR. ROY MULJADI SOETIKNOCredential: MD
Location Address2490 HOSPITAL DR STE 211Mountain View, CA 94040-4125
Mailing Address2490 Hospital Dr Ste 211Mountain View, CA 94040-4125 · (650) 492-3384 · Fax (650) 963-3535
Phone(650) 492-3384
Fax(650) 963-3535
Sole ProprietorNo
Medical School CMSUniversity Of Chicago, Pritzker School Of MedicineGraduated 1990
Enumeration DateAugust 31, 2006
Last NPPES UpdateApril 14, 2020
NPPES CertifiedApril 14, 2020
✔ NPI 1922119916 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code207RG0100X
License✔ Licensed in CA · G76556
Definition
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
2490 HOSPITAL DR STE 211, Mountain View, CA 94040
Open in Google Maps ↗

Secondary Practice Location 1

Location 13801 Miranda Ave # Gi111Palo Alto, CA 94304-1207 · Phone (650) 849-0542

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Roy Muljadi Soetikno Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5294815627
PECOS Enrollment IDI20080110000228
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 Roy Soetikno reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Advanced Gi Endoscopy Inc
Same address
Gastroenterology
2490 HOSPITAL DR, 211
Mountain View, CA 94040
  • Reassigned Medicare billing, California enrollment
  • 2 clinicians in this Medicare group
NPI 1437497096 (650) 988-7488

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 94040 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
$156.67 typical visit price
range $70.37 – $206.04
Typical copayment $39.16 (range $17.59 – $51.51)
Most-billed visit code 99204
Established Patient
$121.77 typical visit price
range $23.96 – $169.60
Typical copayment $30.44 (range $5.99 – $42.40)
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 4

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

CAROLINE LUCZAK
Physician Assistant
2490 HOSPITAL DR STE 211
MOUNTAIN VIEW, CA 94040
Santa Clara County (650) 988-7488
MARY LYN FLEURIMOND NP
Nurse Practitioner
2490 HOSPITAL DR STE 211
MOUNTAIN VIEW, CA 94040
Santa Clara County (650) 988-7781
DR. GEORGE TINAWI MD
Internal Medicine (Gastroenterology)
2490 HOSPITAL DR STE 211
MOUNTAIN VIEW, CA 94040
Santa Clara County (650) 988-7488
LISA M. CHEUNG PA
Physician Assistant (Medical)
2490 HOSPITAL DR STE 211
MOUNTAIN VIEW, CA 94040
Santa Clara County (650) 988-7488

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 Roy Soetikno's NPI number?

The NPI number for Roy Soetikno is 1922119916. It was assigned to this individual provider in the NPPES registry on August 31, 2006.

Where is Roy Soetikno located?

Roy Soetikno practices at 2490 Hospital Dr Ste 211, Mountain View, CA 94040. The listed phone number is (650) 492-3384.

What is Roy Soetikno's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Is Roy Soetikno enrolled in Medicare?

Yes. Roy Soetikno is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Roy Soetikno's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Roy Soetikno reassigns Medicare benefits to Advanced Gi Endoscopy Inc (Mountain View, CA). 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 Roy Soetikno'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 Roy Soetikno was last updated on April 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.