NPIMap

Individual provider Active NPI

Melanchton Atiga Mangoba, M.D.

  • Internal Medicine Physician
  • Riverside, CA
National Provider Identifier
1376605717
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A95444 Issued in CA
Practice address
3838 Sherman Dr Ste 2
Riverside, CA 92503-4001
Phone
(951) 686-3437
Fax
(951) 686-8155
NPI assigned
Dec 14, 2006
Last updated
Jun 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A95444 CA Primary

Addresses

Primary practice location

3838 Sherman Dr Ste 2
Riverside, CA 92503-4001

Mailing address

3838 Sherman Dr Ste 2
Riverside, CA 92503-4001
Phone (951) 686-3437

Other practice location 1

6900 Brockton Ave Ste 200
Riverside, CA 92506-3818
Phone (951) 686-3437

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080317000164 CA Practitioner - Internal Medicine 8224113139 Reassigns benefits to 1 organization
Receives reassigned benefits from 2 practitioners
Practice locations: Pomona, CA; Riverside, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Loma Linda University School of Medicine, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Grace Medical and Wellness ClinicGroup PAC ID 0446608087, 5 clinicians

Practice addresses (Care Compare)

3838 Sherman Dr
Suite 2
Riverside, CA 92503-4001
Phone (951) 686-3437

6900 Brockton Ave
Suite 200
Riverside, CA 92506-3818
Phone (951) 686-3437

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A95444CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allergy, Sinus & Asthma Consultants Inc. CurrentSince Aug 15, 2019 Accepting new patients
Grace Medical and Wellness Clinic Internal Medicine CurrentSince Oct 8, 2023 Accepting new patients
Med Choice LTC Pharmacy LLC CurrentSince Jun 29, 2025 Accepting new patients
Equanimity Hospice & Palliative Care, Inc. CurrentSince Dec 1, 2022 Accepting new patients
Southern California Orthopaedic Specialists Medical Group CurrentSince Jun 29, 2025 Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
Doctors Hospital of Riverside LLC Past Accepting new patients
Luther Mangoba, MD Inc. PastSince Aug 15, 2019 Accepting new patients

Locations

3838 Sherman Dr
Ste 2
Riverside, CA 92503
Phone (951) 354-7270

6377 Riverside Ave
Ste B101
Riverside, CA 92506
Phone (951) 686-0004

6900 Brockton Ave
Ste 200
Riverside, CA 92506
Phone (951) 682-6263

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12935/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: melanchton.mangoba.2@10039.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Mary's Hospice IncDiamond Bar, CA, CCN 751791 Hospice 5% Or Greater Direct Ownership Interest (80%)
Corporate Officer (80%)
Corporate Director (80%)		 Jun 30, 2025
Jun 30, 2025
Jun 30, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • St Mary's Hospice Inc
    • Community Based Hospice Care Agency
    • Diamond Bar, CA
    • NPI 1447517073

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 8

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 6

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": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1376605717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3838 SHERMAN DR STE 2",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925034001",
            "telephone_number": "951-686-3437",
            "fax_number": "951-686-8155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3838 SHERMAN DR STE 2",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925034001",
            "telephone_number": "951-686-3437",
            "fax_number": "951-686-8155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6900 Brockton Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925063818",
            "country_code": "US",
            "telephone_number": "951-686-3437",
            "fax_number": "951-686-8155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANGOBA",
        "first_name": "MELANCHTON",
        "middle_name": "ATIGA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A95444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.