Individual provider Active NPI

Nimmi Varghese Manaloor, M.B.B.S.

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1700029741
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
U0157 Issued in TX
Practice address
19238 Stonehue
San Antonio, TX 78258-3447
Phone
(210) 494-2223
Fax
(210) 941-0142
NPI assigned
Apr 7, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 11014722A IN
Pediatrics Physician 208000000X U0157 TX Primary

Addresses

Primary practice location

19238 Stonehue
San Antonio, TX 78258-3447

Mailing address

6626 E 75TH St
Suite 500
Indianapolis, IN 46250-2805

Other identifiers 1

IdentifierTypeStateIssuer
201186330MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11014722AINMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Aug 12, 2015 Accepting new patients
Community Physicians of Indiana Inc Pediatrics CurrentSince Aug 12, 2015 Accepting new patients
Topcare Medical Group Inc PastSince Oct 9, 2022 Accepting new patients
Abcd Pediatrics Pediatrics PastSince Oct 9, 2022 Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

13121 Olio Rd
Ste 340
Fishers, IN 46037
Phone (317) 621-1340

13121 Olio Rd
Ste 260
Fishers, IN 46037
Phone (317) 621-1300

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

Interoperability endpoints

  • Direct secure messaging: nmanaloor170968@ecommunitydirect.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1700029741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "address_2": "SUITE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19238 STONEHUE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583447",
            "telephone_number": "210-494-2223",
            "fax_number": "210-941-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANALOOR",
        "first_name": "NIMMI",
        "middle_name": "VARGHESE",
        "credential": "M.B.B.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-07",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "11014722A",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "U0157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201186330",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.