NPIMap

Individual provider Active NPI

Mansour Eltaher Khaddr, M.D.

  • Cardiovascular Disease Physician
  • Rock Springs, WY
National Provider Identifier
1124384797
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
12748A Issued in WY
Practice address
1204 Hilltop Dr Ste 106
Rock Springs, WY 82901-5861
Phone
(307) 522-5555
Fax
(888) 819-5155
NPI assigned
Apr 8, 2012
Last updated
Mar 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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 12748A WY Primary
Interventional Cardiology Physician 207RI0011X 12748A WY

Addresses

Primary practice location

1204 Hilltop Dr Ste 106
Rock Springs, WY 82901-5861

Mailing address

1204 Hilltop Dr Ste 106
Rock Springs, WY 82901-5861
Phone (307) 522-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
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
I20200629003746 WY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 8628340742 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Interventional Cardiology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1204 Hilltop Dr
Suite 106
Rock Springs, WY 82901-5861
Phone (307) 382-2466

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12748AWYMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cedars Health Current Accepting new patients
Casper Cardiology Cardiovascular Disease CurrentSince Jul 1, 2020 Accepting new patients
Wyoming Heart and Vascular Center LLC Cardiovascular Disease CurrentSince Aug 31, 2023 Accepting new patients

Locations

3 Penn Ctr W
Ste 127
Pittsburgh, PA 15276

428 S Durbin St
Ste 104
Casper, WY 82601
Phone (307) 337-4284

1204 Hilltop Dr
Ste 106
Rock Springs, WY 82901
Phone (307) 362-5500

1204 Hilltop Dr
Ste 6
Rock Springs, WY 82901

1453 Dewar Dr
#A
Rock Springs, WY 82901
Phone (307) 382-2466

1453 Dewar Dr
Unit A
Rock Springs, WY 82901
Phone (307) 223-0048

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1333843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1124384797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 HILLTOP DR STE 106",
            "city": "ROCK SPRINGS",
            "state": "WY",
            "postal_code": "829015861",
            "telephone_number": "307-522-5555",
            "fax_number": "888-819-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 HILLTOP DR STE 106",
            "city": "ROCK SPRINGS",
            "state": "WY",
            "postal_code": "829015861",
            "telephone_number": "307-522-5555",
            "fax_number": "888-819-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHADDR",
        "first_name": "MANSOUR",
        "middle_name": "ELTAHER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-08",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WY",
            "license": "12748A",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WY",
            "license": "12748A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Springs, WY

Sources for this page

Verify at the official NPI Registry.