Individual provider Active NPI

Manoj Madhu Sangoram, D.O.

  • Anesthesiology Physician
  • Bronx, NY
National Provider Identifier
1093034803
Registry record updated May 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
20A11181 Issued in CA
Practice address
111 E 210TH St
Bronx, NY 10467-2401
Phone
(847) 971-6696
NPI assigned
May 19, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 20A11181 CA Primary

Addresses

Primary practice location

111 E 210TH St
Bronx, NY 10467-2401

Mailing address

3450 Wayne Ave
Apt. 20G
Bronx, NY 10467-2510
Phone (847) 971-6696

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100706000714 CA Practitioner - Anesthesiology 7315078482 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coachella Valley Anesthesia a Professional CorporationGroup PAC ID 5698131969, 126 clinicians

Practice addresses (Care Compare)

420 34TH St
Bakersfield, CA 93301-2237
Phone (661) 324-4647

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A11181CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coachella Valley Anesthesia a Professional Corporation Anesthesiology CurrentSince Oct 1, 2023 Accepting new patients
Palm Springs Anesthesia Services, PC Anesthesiology CurrentSince Aug 31, 2015 Accepting new patients
Desert Anestheisa Medical Group Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

700 W El Norte Pkwy
Escondido, CA 92026
Phone (760) 738-7830

6601 White Feather Rd
Joshua Tree, CA 92252
Phone (760) 366-1500

44139 Monterey Ave
Ste B
Palm Desert, CA 92260
Phone (760) 773-4411

1150 N Indian Canyon Dr
Palm Springs, CA 92262
Phone (760) 323-6251

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 1

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": "1274227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274227200000",
    "number": "1093034803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 WAYNE AVE",
            "address_2": "APT. 20G",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672510",
            "telephone_number": "847-971-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "847-971-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANGORAM",
        "first_name": "MANOJ",
        "middle_name": "MADHU",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-19",
        "last_updated": "2010-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "20A11181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.