NPIMap

Individual provider Active NPI

Tatiana Marie Mamantov, MD

  • Emergency Medicine Physician
  • Castro Valley, CA
National Provider Identifier
1629069059
Registry record updated Jul 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G85179 Issued in CA
Practice address
20103 Lake Chabot Rd
Castro Valley, CA 94546-5341
Phone
(209) 342-2300
Fax
(209) 524-4240
NPI assigned
Nov 3, 2005
Last updated
Jul 30, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G85179 CA Primary

Addresses

Primary practice location

20103 Lake Chabot Rd
Castro Valley, CA 94546-5341

Mailing address

4301 Northstar Way
Modesto, CA 95356-9262
Phone (209) 342-2300

Other identifiers 2

IdentifierTypeStateIssuer
00G851790OtherCABLUE SHIELD
00G851790MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041217000787 CA Practitioner - Emergency MedicinePractitioner - Medical Toxicology 6608833975 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Medical Toxicology
Education
East Tennessee State University Quillen College of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sharp Rees-Stealy Medical Group IncGroup PAC ID 8628972759, 872 clinicians

Practice addresses (Care Compare)

300 Fir St
San Diego, CA 92101-2327
Phone (848) 499-2600

Merit-based Incentive Payment System (MIPS)

Final score
88.67 of 100Reported as group
Quality
81.04
Promoting interoperability
99
Improvement activities
40
Cost
82.04

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G85179CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of California SFGH Medical Group CurrentSince Aug 27, 2012 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Feb 3, 2020 Accepting new patients
University of California SFGH Medical Group Current Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Emergency Medicine CurrentSince Feb 3, 2020 Accepting new patients
University of California SFGH Medical Group CurrentSince Aug 27, 2012 Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Pleasanton Emergency Medical Group Emergency Medicine PastSince May 7, 2023 Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients
Eden Medical Center/San Leandro Hospital Campus Past Accepting new patients

Locations

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

300 Fir St
San Diego, CA 92101
Phone (619) 446-1586

1001 Potrero Ave
Rm 5H22
San Francisco, CA 94110
Phone (628) 206-4774

Interoperability endpoints

  • Direct secure messaging: tmamantov32604@sharphealthcare.direct-ci.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217376000000",
    "number": "1629069059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 NORTHSTAR WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569262",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20103 LAKE CHABOT RD",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465341",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMANTOV",
        "first_name": "TATIANA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-03",
        "last_updated": "2008-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G85179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G851790",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G851790",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Castro Valley, CA

Sources for this page

Verify at the official NPI Registry.