Kumar S Mandal, M.D.

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

182787 Issued in NY

Practice address

2 Coraci Blvd
Ste 10
Shirley, NY 11967-4833

Phone

(631) 281-2600

Fax

(631) 281-6732

NPI assigned

Jun 1, 2005

Reactivated

Mar 27, 2006

Last updated

Jun 2, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Family Practice

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brookhaven Heart PLLCGroup PAC ID 6305846114, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EEFCAA

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.

• Brookhaven Heart PLLC

  • Cardiovascular Disease Physician
  • Patchogue, NY
  • NPI 1639260607
  Medicare reassignment Care Compare group NPD
• Kumar S Mandal MD PC

  • Family Medicine Physician
  • Shirley, NY
  • NPI 1497924476
  Authorized official Same address or phone
• Brookhaven Health Care Facility LLC

  • Skilled Nursing Facility
  • East Patchogue, NY
  • NPI 1386631547
  NPD (past)

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433203200000",
    "number": "1689676884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CORACI BLVD",
            "address_2": "STE 10",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119674833",
            "telephone_number": "631-281-2600",
            "fax_number": "631-281-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CORACI BLVD",
            "address_2": "STE 10",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119674833",
            "telephone_number": "631-281-2600",
            "fax_number": "631-281-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDAL",
        "first_name": "KUMAR",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2015-06-02",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NY",
            "license": "182787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01519864",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lumo-Plus,LLC
• Robert S Lupski, RPH
• Maureen Mackenzie, RN
• Meaghan Mahoney
• Kimberly Lynn Ann Maione, LPN
• Robert Mandelbaum, CASAC
• Andrew Markowitz, D.D.S.
• Christina M Marotta, OTR/L
• Maria Serrano Marrero, SLP
• Kelly Ann Marsicano, LPN

• Adult Medicine Physician in Shirley, NY
• Providers in Shirley, NY by specialty
• Adult Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.