NPIMap

Individual provider Active NPI

Mangaraju Chakka, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Little Rock, AR
National Provider Identifier
1104862200
Registry record updated Jan 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
E4358 Issued in AR
Practice address
10100 Kanis Rd
Little Rock, AR 72205-6202
Phone
(501) 255-6000
Fax
(501) 255-6400
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X E4358 AR
Clinical Cardiac Electrophysiology Physician 207RC0001X E4358 AR Primary

Addresses

Primary practice location

10100 Kanis Rd
Little Rock, AR 72205-6202

Mailing address

10100 Kanis Rd
Little Rock, AR 72205-6202
Phone (501) 255-6000

Other identifiers 2

IdentifierTypeStateIssuer
919591OtherARMALP INS #
157168001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20050513000772 AR Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Other (Physician) 2163463639 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
New York University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Vincent Infirmary Medical Center 44 clinicians

Practice addresses (Care Compare)

10100 Kanis Rd
Little Rock, AR 72205-6202
Phone (501) 255-6000

Hospital & facility affiliations

  • Care IV Home Health Home health agency, Little Rock, AR, CCN 047178
  • CHI-St Vincent Infirmary Hospital, Little Rock, AR, CCN 040007
  • CHI St. Vincent Hospital Hot Springs Hospital, Hot Springs, AR, CCN 040026
  • Baptist Health Medical Center Heber Springs Hospital, Heber Springs, AR, CCN 041312

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair84

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E4358ARMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Cardiovascular Disease CurrentSince Jul 1, 2005 Accepting new patients
St. Vincent Infirmary Medical Center CurrentSince Nov 30, 2009 Accepting new patients
St Vincent Infirmary Medical Center CurrentSince Nov 30, 2009 Accepting new patients
Baptist Health CurrentSince Jul 1, 2005 Accepting new patients
Heart Clinic Arkansas Cardiovascular Disease Current Accepting new patients
St. Vincent Infirmary Medical Center Current Accepting new patients
St Vincent Infirmary Medical Center Past Accepting new patients

Locations

10100 Kanis Rd
Little Rock, AR 72205
Phone (501) 255-6000

2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680

9601 Baptist Health Dr
Little Rock, AR 72205
Phone (501) 202-3995

1708 N Buerkle St
Stuttgart, AR 72160
Phone (870) 659-8050

Interoperability endpoints

  • Direct secure messaging: mchakka456146@direct.stlukeshealth.org

Organizations & group practices 9

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 10

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294099200000",
    "number": "1104862200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 KANIS RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056202",
            "telephone_number": "501-255-6000",
            "fax_number": "501-255-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 KANIS RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056202",
            "telephone_number": "501-255-6000",
            "fax_number": "501-255-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAKKA",
        "first_name": "MANGARAJU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2011-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AR",
            "license": "E4358",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "AR",
            "license": "E4358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MALP INS #",
            "identifier": "919591",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157168001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.