Individual provider Active NPI

Victor L Mandoff, MD

  • Anesthesiology Physician
  • Little Rock, AR
National Provider Identifier
1366542268
Registry record updated Jan 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
E-4786 Issued in AR
Practice address
4301 W Markham St
Uams Slot 515
Little Rock, AR 72205-7101
Phone
(501) 686-7918
Fax
(501) 686-8139
NPI assigned
Sep 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X E-4786 AR Primary

Addresses

Primary practice location

4301 W Markham St
Uams Slot 515
Little Rock, AR 72205-7101

Mailing address

4301 W Markham St
Uams Slot 515
Little Rock, AR 72205-7101
Phone (501) 686-7918

Other identifiers 4

IdentifierTypeStateIssuer
06070017500OtherARQUALCHOICE
P00350684OtherARRAILROAD MEDICARE
E4786OtherARTRICARE
5N541OtherARBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070103000399 AR Practitioner - AnesthesiologyPractitioner - Critical Care (Intensivists) 7618977349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Critical Care (Intensivists)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4301 W Markam St
Little Rock, AR 72205-7101

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-4786ARMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences CurrentSince Apr 18, 2006 Accepting new patients
University of Arkansas for Medical Sciences Anesthesiology CurrentSince Apr 18, 2006 Accepting new patients
Arkansas Childrens Hospital Past Accepting new patients

Locations

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

4301 W Markham St
#515
Little Rock, AR 72205
Phone (501) 603-1656

4301 W Markham St
Little Rock, AR 72205
Phone (501) 603-1278

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199750400000",
    "number": "1366542268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST",
            "address_2": "UAMS SLOT 515",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-686-7918",
            "fax_number": "501-686-8139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST",
            "address_2": "UAMS SLOT 515",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-686-7918",
            "fax_number": "501-686-8139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDOFF",
        "first_name": "VICTOR",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2008-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "E-4786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "06070017500",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00350684",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "E4786",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5N541",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.