Olivia Rochelle Mangeac, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1387 Issued in ID

Practice address

3025 W Cherry LN
Suite B
Meridian, ID 83642-8531

Phone

(208) 302-6450

NPI assigned

Sep 8, 2016

Last updated

Nov 23, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Saint Alphonsus Regional Medical Center Inc

  • Psychologist
  • Boise, ID
  • NPI 1649357716
  Medicare reassignment
• Saint Alphonsus Regional Medical Center Inc

  • Family Medicine Physician
  • Caldwell, ID
  • NPI 1861676298

  Physician Assistant

  NPD
• Functional Medicine of Idaho PC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1336656040
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479859200000",
    "number": "1407303340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-302-6400",
            "fax_number": "208-302-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 W CHERRY LN",
            "address_2": "SUITE B",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428531",
            "telephone_number": "208-302-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGEAC",
        "first_name": "OLIVIA",
        "middle_name": "ROCHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-08",
        "last_updated": "2016-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erik Malm
• Kayla Malone, LMT
• Amanda C Mamrak, PA-C
• Lisa Marie Manery, LCSW
• Tony Mangala
• Danielle Mangun, RN
• Rhema Manning
• Trevor J Manthey
• Ryan Manwaring, DNP
• Shaun Mar, DC

• Physician Assistant in Meridian, ID
• Providers in Meridian, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.