Mansour Eltaher Khaddr, M.D.
Individual provider Active NPI Cardiovascular Disease Physician · Rock Springs, WY
NPI 1124384797 · NPPES record last updated Mar 25, 2024
Key facts
- NPI
- 1124384797
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 12748A (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (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
- Memorial Hospital Sweetwater County
- South Lincoln Medical Center - Cah
- Sublette County Health
- Evanston Regional Hospital
- University of Utah Hospital and Clinics
Merit-based Incentive Payment System (MIPS)
- Final score
- 0 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 0
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200629003746 | WY | Practitioner - Cardiovascular Disease (Cardiology) |
8628340742 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12748A | WY | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Casper Cardiology | Cardiovascular Disease | Current |
Accepting new patients |
| Wyoming Heart and Vascular Center LLC | Cardiovascular Disease | Current |
Accepting new patients |
| Cedars Health | Current | 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 6
Rock Springs, WY 82901
1453 Dewar Dr
Unit A
Rock Springs, WY 82901
Phone (307) 223-0048
1453 Dewar Dr
#A
Rock Springs, WY 82901
Phone (307) 265-2936
1204 Hilltop Dr
Ste 106
Rock Springs, WY 82901
Phone (307) 382-2466
1204 Hilltop Dr
Ste 104
Rock Springs, WY 82901
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Cardiology Physician | 207RI0011X | 12748A | WY | |
| Cardiovascular Disease Physician | 207RC0000X | 12748A | WY | Yes |
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
Other providers in Rock Springs, WY
- Amanda Sue Keen
- Maria L Kendall
- Stacy Jo Kennedy
- Rhonda Marie Kettering
- Cameron Franklin Keys
- Kim C. Kikuts
- Helen D Kim-Sholey
- Kyrstin King
- Jesse T Kirkham
- Christopher Klockman
All providers in Rock Springs, WY · Cardiovascular Disease Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.