NPIMap

Individual provider Active NPI

Anish George Mammen, M.D.

  • Gastroenterology Physician
  • New York, NY
National Provider Identifier
1053574277
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD472422 Issued in PA
Practice address
310 E 24TH St
Apt 1L
New York, NY 10010-4012
Phone
(617) 513-9508
NPI assigned
Jul 8, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD472422 PA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

310 E 24TH St
Apt 1L
New York, NY 10010-4012

Mailing address

4760 Union Deposit Rd
Ste 100
Harrisburg, PA 17111-3744
Phone (717) 545-5099

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201211000580 PA Practitioner - GastroenterologyPractitioner - Internal Medicine 6305155045 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Tufts University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Harrisburg Gastroenterology, LTD.Group PAC ID 4880593847, 10 clinicians

Practice addresses (Care Compare)

4760 Union Deposit Rd
Suite 100
Harrisburg, PA 17111-3744
Phone (717) 545-9811

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.67 of 100Reported as group
Quality
95.35
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy81
Upper gastrointestinal (GI) endoscopy for acid reflux277

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD472422PAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Smith Hma PBC Management, LLC Current Accepting new patients
Harrisburg Gastroenterology, LTD. Gastroenterology CurrentSince Nov 19, 2020 Accepting new patients
Gastroenterology Associates of New Jersey, LLC Gastroenterology Past Accepting new patients

Locations

1500 Dodson Ave
Fort Smith, AR 72901
Phone (479) 441-2600

4760 Union Deposit Rd
Harrisburg, PA 17111
Phone (717) 545-8525

4760 Union Deposit Rd
Ste 100
Harrisburg, PA 17111
Phone (717) 545-9811

Interoperability endpoints

  • Direct secure messaging: anish.mammen@hg.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/JJIGAA

Organizations & group practices 3

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.

Hospital & facility affiliations 11

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": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1053574277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4760 UNION DEPOSIT RD",
            "address_2": "STE 100",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171113744",
            "telephone_number": "717-545-5099",
            "fax_number": "717-545-9979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E 24TH ST",
            "address_2": "APT 1L",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100104012",
            "telephone_number": "617-513-9508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMMEN",
        "first_name": "ANISH",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-08",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD472422",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.