Krystal Penman Mangandi, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C008071 Issued in NC

Practice address

5855 Executive Center Dr
Suite 111
Charlotte, NC 28212-8883

Phone

(704) 537-1202

NPI assigned

Nov 5, 2012

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 NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mental Health Specialty Group PAGroup PAC ID 8921466228, 726 clinicians

Thriveworks Clinical - North Carolina PCGroup PAC ID 8527471200, 109 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634
  Medicare reassignment Care Compare group NPD
• Thriveworks Clinical - North Carolina PC

  • Mental Health Counselor
  • Raleigh, NC
  • NPI 1003303082
  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, NC

  Medicare reassignment NPD

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363651200000",
    "number": "1417201989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 EXECUTIVE CENTER DR",
            "address_2": "SUITE 111",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282128883",
            "telephone_number": "704-537-1202",
            "fax_number": "704-537-1209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5855 EXECUTIVE CENTER DR",
            "address_2": "SUITE 111",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282128883",
            "telephone_number": "704-537-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGANDI",
        "first_name": "KRYSTAL",
        "middle_name": "PENMAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-05",
        "last_updated": "2013-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C008071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lyndsey Helms Mander, NP
• Warsha Kumari Mandhan, MD
• Tridiana Mandujano Molina
• Omar S. Manejwala, M.D.
• Kelsey Dee Mangan, LCSW
• Joshua Manganello
• Dulce Mange, LCSW
• Deanna Ashley Mangieri, DO
• Noah Mangione
• Timothy De Villa Manglicmot, DC

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.