Active NPI
Terry Jay Mandel, DO
- Family Medicine Physician
- Indianapolis, IN
National Provider Identifier
1568475754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 02000682
- Practice address
- 4007 N High School Rd
Indianapolis, IN 46254-2712 - Phone
- (317) 299-2664
- Fax
- (317) 299-2665
- NPI assigned
- Aug 15, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 02000682 | IN | Primary |
Addresses
Primary practice location
4007 N High School Rd
Indianapolis, IN 46254-2712
Mailing address
6626 E 75TH St
Ste 500
Indianapolis, IN 46250-2805
Phone (317) 621-7584
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01424415 | Other | IN | RAIL ROAD PTAN |
| 100073840 | Medicaid | IN | |
| 000000752860 | Other | IN | ANTHEM BCBS |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02000682 | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | Past | Accepting new patients |
Interoperability endpoints
- tmandel129583@ecommunitydirect.com
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428969600000",
"number": "1568475754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6626 E 75TH ST",
"address_2": "STE 500",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462502805",
"telephone_number": "317-621-7584",
"fax_number": "317-957-2705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4007 N HIGH SCHOOL RD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462542712",
"telephone_number": "317-299-2664",
"fax_number": "317-299-2665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDEL",
"first_name": "TERRY",
"middle_name": "JAY",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2015-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "02000682",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD PTAN",
"identifier": "P01424415",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100073840",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000752860",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.