Sally M Mandichak

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

0101267386 Issued in VA

Practice address

740 California Ave
Reno, NV 89509

Phone

(775) 233-5300

NPI assigned

Sep 12, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• South Lyon Health Center, Inc.

  • Critical Access Hospital
  • Yerington, NV
  • NPI 1376917302
  Medicare reassignment NPD
• South Lyon Health Center, Inc.

  • General Acute Care Hospital
  • Yerington, NV
  • NPI 1932160363
  Medicare reassignment NPD
• South Lyon Health Center, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Yerington, NV
  • NPI 1285008219
  NPD
• South Lyon Health Center, Inc.

  • Physical Therapist
  • Yerington, NV
  • NPI 1407815194
  NPD

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

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1124547930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MERCY CIRCLE OCEANSIDE",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "92055",
            "telephone_number": "775-233-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 CALIFORNIA AVE",
            "city": "RENO",
            "state": "NV",
            "postal_code": "89509",
            "telephone_number": "775-233-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDICHAK",
        "first_name": "SALLY",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-12",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101267386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Mancilla, LCSW
• Graciela S Mancini, RD
• Heather Mandell
• Lisa M Mandell, PA
• Deanna Mandichak, P.T.
• Monique Anne Mandin-Jones, OTR
• Anamaria Manea, MD
• Luigi Mangiacotti, DO
• Angelina Mangili
• Amelia Mangune

• Emergency Medicine Physician in Reno, NV
• Providers in Reno, NV by specialty
• Emergency Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.