Mehrdad Ali Mansouri, M.D., PH.D.
Individual provider Active NPI Hospitalist Physician · Martinez, CA
NPI 1376532747 · NPPES record last updated Feb 11, 2022
Key facts
- NPI
- 1376532747
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hospitalist Physician 208M00000X
- License
- A101584 (CA)
- Practice address
- 2500 Alhambra Ave
Martinez, CA 94553-3156 - Phone
- (925) 370-5200
- NPI assigned
- Oct 18, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Albany Medical College of Union University, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Permanente Medical Group Inc
Practice addresses (Care Compare)
1425 S Main St
Walnut Creek, CA 94596-5318
Phone (925) 295-4000
Hospital & facility affiliations
- Kaiser Foundation Hospital - Oakland/Richmond
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131024001620 | CA | Practitioner - Family Practice |
1850537739 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A101584 | CA | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John Muir Physician Network | Current |
Accepting new patients | |
| Permanente Medical Group Inc | Current |
Accepting new patients | |
| Permanente Medical Group, Inc | Current |
Accepting new patients | |
| Permanente Medical Group Inc | Current | Accepting new patients | |
| Providence Medical Foundation | Current | Accepting new patients | |
| Bitter Creek Inpatient Services LLC | Hospitalist | Past | Accepting new patients |
| Providence Medical Foundation | Past | Accepting new patients | |
| St. Joseph Health Northern California, LLC | Past | Accepting new patients |
Locations
2400 Balfour Rd
Ste 120
Brentwood, CA 94513
Phone (925) 308-8112
2500 Alhambra Ave
Martinez, CA 94553
Phone (925) 370-5000
1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015
901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500
2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000
710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400
7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000
975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000
1425 S Main St
Walnut Creek, CA 94596
Phone (925) 295-4130
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | A101584 | CA | Yes |
Addresses
Primary practice location
2500 Alhambra Ave
Martinez, CA 94553-3156
Mailing address
528 Clyne CT
Benicia, CA 94510-3842
Phone (707) 365-7039
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Other providers in Martinez, CA
- Wendy Malone
- Stanley Manalansan
- Victoria A. Mancuso
- Kim M Mangante
- Cyrus Manian
- Wilfredo Manuntag
- Alexis Mapel
- Neeraja V. Maramreddy
- Amber Dawn Marcellin
- Jade Emmanny Batungbacal Marcos
All providers in Martinez, CA · Hospitalist Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.