NPIMap

Individual provider Active NPI

Kathleen Brown Mantaro, MD

  • Internal Medicine Physician
  • Fishkill, NY
National Provider Identifier
1205936507
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
187691 Issued in NY
Practice address
400 Westage Business Ctr Dr Ste 210
Fishkill, NY 12524-2266
Phone
(845) 838-8480
NPI assigned
Sep 25, 2006
Last updated
Jan 5, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 187691 NY Primary

Addresses

Primary practice location

400 Westage Business Ctr Dr Ste 210
Fishkill, NY 12524-2266

Mailing address

243 North Rd Ste 304
Poughkeepsie, NY 12601-1173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140911001310 NY Practitioner - Internal Medicine 7214828839 Reassigns benefits to 2 organizations
I20171215000962 CT Practitioner - Internal Medicine 7214828839 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Albany Medical College of Union University, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

400 Westage Business Ctr Dr
Suite 210
Fishkill, NY 12524-2266
Phone (845) 838-8480

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Jan 1, 2015 Accepting new patients
Premier Medical Group of the Hudson Valley P.C. Internal Medicine CurrentSince Mar 2, 2020 Accepting new patients
Nuvance Health Medical Practice CT, Inc. Internal Medicine CurrentSince Mar 16, 2020 Accepting new patients
Premier Medical Group of the Hudson Valley, P.C. CurrentSince Mar 2, 2020 Accepting new patients
Optum Medical Care, P.C. CurrentSince Jan 1, 2015 Accepting new patients

Locations

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

50 Hospital Hill Rd
Sharon, CT 06069
Phone (860) 364-4000

400 Westage Business Ctr Dr
Ste 210
Fishkill, NY 12524
Phone (845) 838-8480

600 Westage Business Ctr Dr
#D
Fishkill, NY 12524

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

243 North Rd
Ste 304
Poughkeepsie, NY 12601
Phone (845) 451-7251

45 Reade Pl
Poughkeepsie, NY 12601
Phone (845) 331-3131

Philadelphia, PA 19195

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: kmantaro@premiermedicalhv.medentdirect.com

Organizations & group practices 5

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 10

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": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1205936507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 NORTH RD STE 304",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 WESTAGE BUSINESS CTR DR STE 210",
            "city": "FISHKILL",
            "state": "NY",
            "postal_code": "125242266",
            "telephone_number": "845-838-8480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTARO",
        "first_name": "KATHLEEN",
        "middle_name": "BROWN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "187691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishkill, NY

Sources for this page

Verify at the official NPI Registry.