Individual provider Active NPI

Khalifa Mansour, MD

  • Neurology Physician
  • Downey, CA
National Provider Identifier
1538166418
Registry record updated Jun 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
A47873 Issued in CA
Practice address
8043 2ND St
Ste 105
Downey, CA 90241-3621
Phone
(562) 862-1134
Fax
(562) 861-9895
NPI assigned
Jul 7, 2005
Last updated
Jun 9, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X A47873 CA Primary

Addresses

Primary practice location

8043 2ND St
Ste 105
Downey, CA 90241-3621

Mailing address

8043 2ND St
Ste 105
Downey, CA 90241-3621
Phone (562) 862-1134

Other identifiers 1

IdentifierTypeStateIssuer
00A478730MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060308000890 CA Practitioner - Neurology 3173530631 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8043 2ND St
Suite 105
Downey, CA 90241-3692
Phone (562) 862-1134

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A47873CAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Khalifa Mansour, MD, a Medical Corporation Neurology CurrentSince Dec 1, 1998 Accepting new patients
Pih Health Whittier Hospital Past Accepting new patients
Pih Health Downey Hospital Past Accepting new patients

Locations

11480 Brookshire Ave
Ste 106
Downey, CA 90241
Phone (562) 862-1134

11500 Brookshire Ave
Downey, CA 90241
Phone (562) 904-5000

8043 2nd St
Ste 105
Downey, CA 90241
Phone (562) 862-1134

3630 E Imperial Hwy
Lynwood, CA 90262
Phone (310) 900-7420

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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 1

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402272000000",
    "number": "1538166418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8043 2ND ST",
            "address_2": "STE 105",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902413621",
            "telephone_number": "562-862-1134",
            "fax_number": "562-861-9895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8043 2ND ST",
            "address_2": "STE 105",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902413621",
            "telephone_number": "562-862-1134",
            "fax_number": "562-861-9895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "KHALIFA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2014-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A47873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A478730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Downey, CA

Sources for this page

Verify at the official NPI Registry.