NPIMap

Organization Active NPI

Mandell & Blau, MD's PC

Doing business as Open MRI of Glastonbury

  • Diagnostic Radiology Physician
  • Glastonbury, CT
National Provider Identifier
1679776835
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MANDELL & BLAU, MD'S PC
Doing business as
Open MRI of Glastonbury
Practice address
124 Hebron Ave Ste 1B
Glastonbury, CT 06033-2063
Phone
(860) 657-2242
Fax
(860) 657-2264
NPI assigned
Jun 6, 2007
Last updated
Aug 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Authorized official

Name
Dr. Neal Barkoff, M.D.NPI 1669431904
Title
President
Phone
(860) 633-8806

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

124 Hebron Ave Ste 1B
Glastonbury, CT 06033-2063

Mailing address

PO Box 230
Glastonbury, CT 06033-0230
Phone (860) 633-8806

Other identifiers 7

IdentifierTypeStateIssuer
294659OtherCTWELCARE/PREFERRED ONE
4000931MedicaidCT
CF9509OtherCTRAILROAD MEDICARE
15MRI0016CT03OtherCTANTHEM BC/BS
A369503OtherCTOXFORD
2V0862OtherCTHEALTHNET
780678OtherCTCONNECTICARE

Other names 1

  • Open MRI of Glastonbury Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031223000075 CT Part B Supplier - Clinic/Group Practice 3375441777 Receives reassigned benefits from 10 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glastonbury, CT; Middletown, CT; South Windsor, CT

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mandell Blau MD's PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1679776835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060330230",
            "telephone_number": "860-633-8806",
            "fax_number": "860-657-3788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 HEBRON AVE STE 1B",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332063",
            "telephone_number": "860-657-2242",
            "fax_number": "860-657-2264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDELL & BLAU, MD'S PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "BARKOFF",
        "authorized_official_first_name": "NEAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-633-8806",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELCARE/PREFERRED ONE",
            "identifier": "294659",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4000931",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CF9509",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "15MRI0016CT03",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "A369503",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "2V0862",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "780678",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Open MRI of Glastonbury",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Open MRI of Glastonbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glastonbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.