Active NPI
Jussein Rigor Mangondato, M.D.
- Pediatrics Physician
- Stockton, CA
National Provider Identifier
1306957279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A82555
- Practice address
- 701 E Channel St
Stockton, CA 95202-2628 - Phone
- (209) 944-4700
- NPI assigned
- Aug 31, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A82555 | CA | Primary |
Addresses
Primary practice location
701 E Channel St
Stockton, CA 95202-2628
Mailing address
PO Box 779
Stockton, CA 95201-0779
Phone (209) 373-2800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0071200 | Medicaid | CA |
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 |
|---|---|---|---|
| 82555 | CA | MD | Pharmacist |
| A82555 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Medical Associates of Sacramento Inc | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- jmangondato768365@direct.ochin.org
- jussein.mangondato.p1@direct.cmcentersinc.nextgenshare.com
Organizations & group practices 1
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.
-
dba Pediatric Associates
- Pediatrics Physician
- Sacramento, CA
- NPI 1760570600
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327881600000",
"number": "1306957279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 779",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952010779",
"telephone_number": "209-373-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 E CHANNEL ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952022628",
"telephone_number": "209-944-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGONDATO",
"first_name": "JUSSEIN",
"middle_name": "RIGOR",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2012-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A82555",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0071200",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.