NPIMap

Individual provider Active NPI

Mamata Myneni

  • Diagnostic Radiology Physician
  • Durham, NC
National Provider Identifier
1043416654
Registry record updated Sep 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A130515 Issued in CA
Practice address
2100 Erwin Rd
Banner Good Samaritan Medical Center
Durham, NC 27705-3941
Phone
(919) 684-8111
NPI assigned
Jun 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A130515 CA Primary
Diagnostic Radiology Physician 2085R0202X ME125336 FL

Addresses

Primary practice location

2100 Erwin Rd
Banner Good Samaritan Medical Center
Durham, NC 27705-3941

Mailing address

5213 S Alston Ave
Durham, NC 27713-4430
Phone (919) 620-8111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, FL, TX, AZ4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20140820002124 CA Practitioner - Diagnostic Radiology 1355505355 Reassigns benefits to 11 organizations
I20151020001872 FL Practitioner - Diagnostic Radiology 1355505355 Practice locations: Palm Beach Gardens, FL
I20210324000373 TX Practitioner - Diagnostic Radiology 1355505355 Reassigns benefits to 5 organizations
I20241029002454 AZ Practitioner - Diagnostic Radiology 1355505355 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
New York Medical College, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
District Medical Group IncGroup PAC ID 7315086691, 454 clinicians

Practice addresses (Care Compare)

2601 E Roosevelt St
Phoenix, AZ 85008-4973
Phone (602) 344-5011

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A130515CAMDDiagnostic Radiology Physician
ME125336FLMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Mar 1, 2021 Accepting new patients
Ton Sells Hospital CurrentSince Mar 1, 2021 Accepting new patients
Ton San Simon Health Center CurrentSince Mar 1, 2021 Accepting new patients
Mori Bean and Brooks Inc Diagnostic Radiology CurrentSince Jan 1, 2023 Accepting new patients
Ton San Xavier Health Center CurrentSince Mar 1, 2021 Accepting new patients
Elite Imaging LLC Diagnostic Radiology CurrentSince Sep 1, 2020 Accepting new patients
District Medical Group, Inc Current Accepting new patients
Kern County Hospital Authority CurrentSince Dec 1, 2024 Accepting new patients
Radiology Alliance PC Diagnostic Radiology CurrentSince Feb 1, 2022 Accepting new patients
Kern County Hospital Authority CurrentSince Dec 1, 2024 Accepting new patients
Geisinger Clinic Diagnostic Radiology CurrentSince Feb 18, 2021 Accepting new patients
District Medical Group, Inc CurrentSince Aug 24, 2024 Accepting new patients
Lechee Health Facility Family Medicine CurrentSince Mar 1, 2021 Accepting new patients
District Medical Group, Inc CurrentSince Aug 24, 2024 Accepting new patients
West Florida Radiology Associates PA Diagnostic Radiology CurrentSince Feb 1, 2023 Accepting new patients
Imaging Center of West Palm Beach LLC CurrentSince Mar 1, 2018 Accepting new patients
Sonoran Radiology LTD Diagnostic Radiology CurrentSince Mar 10, 2021 Accepting new patients
Southern Monterey County Memorial Hospital Current Accepting new patients
Claremont Imaging Associates, a Medical Corporation Diagnostic Radiology CurrentSince Jun 10, 2024 Accepting new patients
Donalsonville Hospital Inc CurrentSince Aug 1, 2023 Accepting new patients
Elite Imaging, LLC Diagnostic Radiology CurrentSince Sep 1, 2020 Accepting new patients
Casa Colina Hospital and Centers for Healthcare Current Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine Current Accepting new patients
Imaging Center of West Palm Beach LLC CurrentSince Mar 1, 2018 Accepting new patients
The Fort Defiance Indian Hospital Board, Incorporation CurrentSince Mar 10, 2021 Accepting new patients
Silicon Valley Medical Imaging Inc a Medical Corporation CurrentSince Jun 1, 2014 Accepting new patients
Hni Medical Services of California, PC Past Accepting new patients
Pacific Imaging Consultants, a Medical Group, Inc. Diagnostic Radiology Past Accepting new patients
Ton San Xavier Health Center Past Accepting new patients
Ton Sells Hospital Past Accepting new patients
District Medical Group, Inc Family Medicine Past Accepting new patients

Locations

5555 W Thunderbird Rd
Glendale, AZ 85306
Phone (602) 588-5555

1201 S Alma School Rd
Ste 14500
Mesa, AZ 85210
Phone (602) 698-7715

8088 W Whitney Dr
Peoria, AZ 85345
Phone (602) 655-2000

2601 E Roosevelt St
Ste 0D10
Phoenix, AZ 85008

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043

7900 S J Stock Rd
Tucson, AZ 85746
Phone (520) 295-2550

1700 Mount Vernon Ave
Bakersfield, CA 93306
Phone (616) 326-2000

2191 Mowry Ave
Ste 500H
Fremont, CA 94538
Phone (415) 595-8687

39120 Argonaut Way
Fremont, CA 94538
Phone (510) 378-3036

300 Canal St
King City, CA 93930
Phone (831) 385-6000

450 Stanyan St
San Francisco, CA 94117
Phone (415) 668-1000

151 E Redstone Ave
Crestview, FL 32539
Phone (850) 629-8515

20997 Old Cutler Rd
Cutler Bay, FL 33189
Phone (786) 595-1780

160 Twin Springs Way
Defuniak Springs, FL 32435
Phone (850) 389-6955

8375 Dix Ellis Trl
Ste 201
Jacksonville, FL 32256
Phone (904) 399-5810

102 Hospital Cir
Donalsonville, GA 39845
Phone (229) 524-8489

3310 Aspen Grove Dr
Ste 203
Franklin, TN 37067
Phone (615) 771-8274

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: mmyneni3831@direct.valleywisehealth.org
  • Direct secure messaging: casacolina@direct.casacolina.org

Organizations & group practices 31

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 31

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441929600000",
    "number": "1043416654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 S ALSTON AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277134430",
            "telephone_number": "919-620-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 ERWIN RD",
            "address_2": "BANNER GOOD SAMARITAN MEDICAL CENTER",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277053941",
            "telephone_number": "919-684-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYNENI",
        "first_name": "MAMATA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-22",
        "last_updated": "2015-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A130515",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME125336",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.