Mandelbaum Surgical PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

MANDELBAUM SURGICAL PC

Doing business as

Indy Southside Surgical

Practice address

5255 E Stop 11 Rd
Suite 450
Indianapolis, IN 46237-6340

Phone

(317) 856-4800

Fax

(317) 865-4806

NPI assigned

Oct 3, 2006

Organization subpart

No

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

Authorized official

Name

Dena L Petty

Title

Manager

Phone

(317) 865-4800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Indy Southside Surgical Doing business as

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David M Mandelbaum, MD

  • Surgery Physician
  • Greenwood, IN
  • NPI 1932173788
  NPD
• Katherine Irene Boone

  • Surgical Physician Assistant
  • Indianapolis, IN
  • NPI 1215196241
  NPD (past)
• Mark R Edwards, MD

  • Surgery Physician
  • Mooresville, IN
  • NPI 1710180518
  NPD (past)
• Donald G King, MD

  • Surgery Physician
  • Indianapolis, IN
  • NPI 1790759546
  NPD (past)
• Jonathan A Mandelbaum, MD

  • Surgery Physician
  • Indianapolis, IN
  • NPI 1437123437
  NPD (past)
• Christopher Andrew Reising, M.D.

  • Surgery Physician
  • Boise, ID
  • NPI 1285699165
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144314097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5255 E STOP 11 RD",
            "address_2": "SUITE 450",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462376340",
            "telephone_number": "317-856-4800",
            "fax_number": "317-865-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5255 E STOP 11 RD",
            "address_2": "SUITE 450",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462376340",
            "telephone_number": "317-856-4800",
            "fax_number": "317-865-4806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDELBAUM SURGICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "DENA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "317-865-4800"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP NUMBER",
            "identifier": "CE6013",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indy Southside Surgical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shalini K Manchanda, MD
• Brian David Mancke, MD
• Gilford Manco
• Pooja Naginroy Mandalia, DDS
• Terry Jay Mandel, DO
• Jonathan A Mandelbaum, MD
• Tricia Ann Mandelbaum, M.A., CCC-A
• Shai Y Mandelboim, M.D
• Adam Mandrell
• Sudha Manepalli, FNP-C

• Surgery Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.