Ted M Mandryk, MEDICAL DOCTOR

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

G64121 Issued in CA

Practice address

3291 Loma Vista Rd
Ventura, CA 93003-3099

Phone

(805) 652-6165

NPI assigned

Nov 2, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Emergency MedicineAlso: Family Practice

Education

University of California, Irvine, California College of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of VenturaGroup PAC ID 7911810171, 340 clinicians

Seaside Emergency AssociatesGroup PAC ID 8527385061, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ventura County Medical Center Hospital, Ventura, CA, CCN 050159

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.

• Seaside Emergency Associates

  • Emergency Medicine Physician
  • Ventura, CA
  • NPI 1639577802
  Medicare reassignment Care Compare group NPD
• County of Ventura

  • General Acute Care Hospital
  • Ventura, CA
  • NPI 1629167457
  Medicare reassignment Care Compare group
• County of Ventura

  • Federally Qualified Health Center (FQHC)
  • Thousand Oaks, CA
  • NPI 1316188253
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• County of Ventura

  • General Acute Care Hospital
  • Ventura, CA
  • NPI 1629167457
  Care Compare affiliation

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204243200000",
    "number": "1164413886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3291 LOMA VISTA RD",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930033099",
            "telephone_number": "805-652-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3291 LOMA VISTA RD",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930033099",
            "telephone_number": "805-652-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDRYK",
        "first_name": "TED",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MEDICAL DOCTOR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2008-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G64121",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "CA",
            "license": "G64121",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G641210",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra Maloney
• Penelope Ann Malvaez
• Farida Khay Mamalompong
• Dominique Manasson, D.C.
• Tiffany Mandelbaum
• Judith Lorain Mangione, CMP
• Manju Sharma, MD, Inc.
• Renato Manlutac, P.T.
• Kirk Mann, L.AC., M.AC.
• Nicole Mann, OT

• Emergency Medicine Physician in Ventura, CA
• Providers in Ventura, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.