NPIMap

Individual provider Active NPI

Victoria T Mansour, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Macon, GA
National Provider Identifier
1265444228
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
054495 Issued in GA
Practice address
3312 Northside Dr Ste A110
Macon, GA 31210-2520
Phone
(478) 477-2314
Fax
(478) 477-3599
NPI assigned
Aug 11, 2006
Last updated
Nov 20, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 054495 GA Primary

Addresses

Primary practice location

3312 Northside Dr Ste A110
Macon, GA 31210-2520

Mailing address

3312 Northside Dr Ste A110
Macon, GA 31210-2520
Phone (478) 477-2314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, PA2 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
I20040811000383 GA Practitioner - Physical Medicine and Rehabilitation 5092603373 Reassigns benefits to 1 organization
I20250902002820 PA Practitioner - Physical Medicine and Rehabilitation 5092603373 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
H2 Rehabilitation Extension Services LLCGroup PAC ID 6406131622, shared by 5 NPIs, 161 clinicians
Sanative Healthcare PLLCGroup PAC ID 1951891431, 2 clinicians
Keystone Rehabilitation Systems IncGroup PAC ID 7012826753, shared by 15 NPIs, 750 clinicians

Practice addresses (Care Compare)

137 Montgomery Ave
Boyertown, PA 19512-1300
Phone (484) 658-3150

1623 Morgantown Rd
Reading, PA 19607-9455
Phone (802) 735-0001

321 N Furnace St
Birdsboro, PA 19508-2057
Phone (610) 582-2250

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Rehabilitation Corp Pain Medicine CurrentSince Mar 31, 2004 Accepting new patients
Penn Healthcare PLLC CurrentSince Jul 1, 2025 Accepting new patients
Sanative Healthcare PLLC CurrentSince Sep 7, 2025 Accepting new patients
St. Marks Physical Therapy, P.C Past Accepting new patients
Pain Treatment Center of Wyoming, LLC Past Accepting new patients

Locations

3312 Northside Dr
Ste A110
Macon, GA 31210
Phone (478) 477-2314

801 Springdale Dr
Ste 100M
Exton, PA 19341

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDBAED/Endpoint/JDBAED

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 11

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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1265444228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3312 NORTHSIDE DR STE A110",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102520",
            "telephone_number": "478-477-2314",
            "fax_number": "478-477-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 NORTHSIDE DR STE A110",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102520",
            "telephone_number": "478-477-2314",
            "fax_number": "478-477-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "VICTORIA",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "GA",
            "license": "054495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.