Active NPI
Jerold J. Mangas, M.D.
- Family Medicine Physician
- Mesa, AZ
National Provider Identifier
1285693358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 11635
- Practice address
- 1950 S Country Club Dr
Mesa, AZ 85210-6008 - Phone
- (480) 969-1446
- Fax
- (480) 464-8652
- NPI assigned
- Mar 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11635 | AZ | |
| Family Medicine Physician | 207Q00000X | 11635 | AZ | Primary |
Addresses
Primary practice location
1950 S Country Club Dr
Mesa, AZ 85210-6008
Mailing address
1950 S Country Club Dr
Mesa, AZ 85210-6008
Phone (480) 969-1446
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2Z6143 | Other | AZ | HEALTHNET |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11635 | AZ | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208995200000",
"number": "1285693358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 S COUNTRY CLUB DR",
"city": "MESA",
"state": "AZ",
"postal_code": "852106008",
"telephone_number": "480-969-1446",
"fax_number": "480-464-8652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1950 S COUNTRY CLUB DR",
"city": "MESA",
"state": "AZ",
"postal_code": "852106008",
"telephone_number": "480-969-1446",
"fax_number": "480-464-8652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGAS",
"first_name": "JEROLD",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-18",
"last_updated": "2008-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AZ",
"license": "11635",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "11635",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "2Z6143",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.