Active NPI
Mark G Mandabach, MD
- Anesthesiology Physician
- Birmingham, AL
National Provider Identifier
1437188547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 20064
- Practice address
- 619 19TH Street South
Birmingham, AL 35233 - Phone
- (205) 934-6600
- NPI assigned
- Jul 1, 2006
- Last updated
- Jun 14, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 20064 | AL | Primary |
Addresses
Primary practice location
619 19TH Street South
Birmingham, AL 35233
Mailing address
PO Box 55310
Birmingham, AL 35255-5310
Phone (205) 731-9701
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000037019 | Medicaid | AL | |
| 00117432 | Other | MS | MISSISSIPPI MEDICAID |
| 010033CG35508 | Other | AL | SECTION 1011 |
| 051511203 | Other | AL | BLUE CROSS |
| 051538257 | Other | AL | BCBS |
| 009940371 | Medicaid | AL | |
| 050045414 | Other | AL | RAILROAD MEDICARE |
| 051511202 | Other | AL | BLUE CROSS |
| 000037019 | Other | AL | BLUE CROSS |
| G35508 | Other | AL | VIVA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20064 | AL | MD | Anesthesiology Physician |
Interoperability endpoints
- mmandabach@direct.uabmedicine.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308009600000",
"number": "1437188547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 55310",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352555310",
"telephone_number": "205-731-9701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 19TH STREET SOUTH",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "35233",
"telephone_number": "205-934-6600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDABACH",
"first_name": "MARK",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-01",
"last_updated": "2011-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "AL",
"license": "20064",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000037019",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSISSIPPI MEDICAID",
"identifier": "00117432",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECTION 1011",
"identifier": "010033CG35508",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "051511203",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "051538257",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009940371",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "050045414",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "051511202",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "000037019",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIVA",
"identifier": "G35508",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.