NPIMap

Individual provider Active NPI

Simardeep Mangat, MD

  • Nephrology Physician
  • Syracuse, NY
National Provider Identifier
1063518074
Registry record updated May 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
235907 Issued in NY
Practice address
1304 Buckley Rd
Syracuse, NY 13212-4311
Phone
(315) 478-3311
Fax
(315) 426-0796
NPI assigned
Sep 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 235907 NY
Nephrology Physician 207RN0300X 235907 NY Primary

Addresses

Primary practice location

1304 Buckley Rd
Syracuse, NY 13212-4311

Mailing address

1304 Buckley Road
Syracuse, NY 13212
Phone (315) 478-3311

Other identifiers 2

IdentifierTypeStateIssuer
02969271MedicaidNY
204496170OtherNYEXCELLUS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20080519000777 NY Practitioner - Nephrology 8628147568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Columbia University College of Physicians and Surgeons, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates of Syracuse, P.C.Group PAC ID 2769379015, 13 clinicians

Practice addresses (Care Compare)

1304 Buckley Rd
Suite 200
Syracuse, NY 13212-4317
Phone (315) 478-3311

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
235907NYMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates of Syracuse, P.C. Nephrology CurrentSince Jul 1, 2008 Accepting new patients

Locations

1304 Buckley Rd
Syracuse, NY 13212
Phone (315) 478-3311

1304 Buckley Rd
Ste 200
Syracuse, NY 13212
Phone (315) 478-3311

4857 State Route 5
Vernon, NY 13476
Phone (315) 363-9995

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BEAGBA/Endpoint/BEAGBA
  • Direct secure messaging: smangat@hiemail.healtheconnections.org

Organizations & group practices 1

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 9

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": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337299200000",
    "number": "1063518074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 BUCKLEY ROAD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13212",
            "telephone_number": "315-478-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 BUCKLEY RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132124311",
            "telephone_number": "315-478-3311",
            "fax_number": "315-426-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGAT",
        "first_name": "SIMARDEEP",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2012-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "235907",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "235907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02969271",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS",
            "identifier": "204496170",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.