Kelly Ann Mandagere, M.D.

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

45001 Issued in CO

Practice address

892 W South Boulder Rd
Louisville, CO 80027-2453

Phone

(303) 586-5200

Fax

(303) 586-5201

NPI assigned

Dec 13, 2006

Last updated

Jul 20, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Boulder Endocrinology Physicians

  dba Boulder Endocrinology PLLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Louisville, CO
  • NPI 1588817464
  Authorized official Same address or phone

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279584000000",
    "number": "1255492104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "892 W SOUTH BOULDER RD",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800272453",
            "telephone_number": "303-586-5200",
            "fax_number": "303-586-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "892 W SOUTH BOULDER RD",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800272453",
            "telephone_number": "303-586-5200",
            "fax_number": "303-586-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDAGERE",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2010-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CO",
            "license": "45001",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "45001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01159305",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81287895",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Street Provider Network Inc (Omni Eye Specialists)
• Maria Christianne Maldonado Rader, L.M.T
• Mary Berg Malkiel, RN. LAC
• Elizabeth Malouf, ND
• Thomas L Manchester, MD
• Thomas A Mann, M.D.
• Jill Manning, PH.D., LMFT, CCPS
• Elyse Marinelli, LCSW
• Alexia Maroun, LCSW
• Anna F Marshall, DPT

• Endocrinology, Diabetes & Metabolism Physician in Louisville, CO
• Providers in Louisville, CO by specialty
• Endocrinology, Diabetes & Metabolism Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; 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.