NPIMap

Individual provider Active NPI

Vanessa Jaiashree Mandal, MD

  • Internal Medicine Physician
  • Roseville, CA
National Provider Identifier
1114981818
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C55495 Issued in CA
Practice address
2110 Professional Drive
Suite 120
Roseville, CA 95661-0000
Phone
(916) 536-2500
Fax
(281) 545-1442
NPI assigned
Apr 12, 2006
Last updated
Oct 25, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 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 M1435 TX
Internal Medicine Physician 207R00000X C55495 CA Primary

Addresses

Primary practice location

2110 Professional Drive
Suite 120
Roseville, CA 95661-0000

Mailing address

3400 Data Drive
Physician Support Services
Rancho Cordova, CA 95670-7956
Phone (916) 379-2948

Other identifiers 4

IdentifierTypeStateIssuer
MD1435TXOtherTXWORKERS COMPENSATION
8G6218OtherTXBC/BS TX#
178386201MedicaidTX
P00301395OtherTXRAILROAD GBA - RAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C55495CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Internal Medicine Past Accepting new patients
South Texas Medical Clinics, P.a. Past Accepting new patients
Montefiore Medical Center Past Accepting new patients
South Texas Medical Clinics, P.a. Past Accepting new patients
Texas Home Health Skilled Services,LP Past Accepting new patients
Texas Home Health Skilled Services, LP PastSince Sep 3, 2025 Accepting new patients

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351123200000",
    "number": "1114981818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DRIVE",
            "address_2": "PHYSICIAN SUPPORT SERVICES",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956",
            "telephone_number": "916-379-2948",
            "fax_number": "916-858-7065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 PROFESSIONAL DRIVE",
            "address_2": "SUITE 120",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956610000",
            "telephone_number": "916-536-2500",
            "fax_number": "281-545-1442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDAL",
        "first_name": "VANESSA",
        "middle_name": "JAIASHREE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-12",
        "last_updated": "2012-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "M1435",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C55495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "MD1435TX",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS TX#",
            "identifier": "8G6218",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178386201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD GBA - RAILROAD MEDICARE",
            "identifier": "P00301395",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.