NPIMap

Organization Active NPI

Shahid Mansoor MD, Apmc

  • Pediatrics Physician
  • Alexandria, LA
National Provider Identifier
1700981792
Registry record updated Oct 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
13654R Issued in LA
Legal business name
SHAHID MANSOOR MD, APMC
Practice address
501 Medical Center Dr Ste 3a
Alexandria, LA 71301-8124
Phone
(318) 484-3899
Fax
(318) 484-3887
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2007

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

Authorized official

Name
Dr. Shahid Mansoor, MD
Title
Owner/Operator
Phone
(318) 484-3899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 13654R LA Primary

Addresses

Primary practice location

501 Medical Center Dr Ste 3a
Alexandria, LA 71301-8124

Mailing address

501 Medical Center Dr Ste 3a
Alexandria, LA 71301-8124
Phone (318) 484-3899

Other identifiers 4

IdentifierTypeStateIssuer
1314579MedicaidLA
1435350MedicaidLA
1161110MedicaidLA
1445215MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071213000151 LA Part A Provider - Rural Health Clinic 0840231791 Practice locations: Pineville, LA

Rural health clinic certification: CCN 193887

Legal name
SHAHID MANSOOR, M.D. A PROFESSIONAL MEDICAL CORPORATION
Doing business as
HEALTHY STEPS PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 25, 2008
Last certification
Feb 6, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Oct 19, 2000 in LA
Enrollment address
192 Stilley Road
Healthy Steps Pediatrics
Pineville, LA 71360-5933

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shahid Mansoor MD a Profe3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

501 Medical Center Dr
Ste 3B2
Alexandria, LA 71301

501 Medical Center Dr
Ste 31
Alexandria, LA 71301

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shahid Mansoor Individual 5% Or Greater Direct Ownership Interest Mar 28, 2007
Corporate Director Mar 28, 2007
W-2 Managing EmployeePresident Mar 28, 2007 100%

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1700981792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MEDICAL CENTER DR STE 3A",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713018124",
            "telephone_number": "318-484-3899",
            "fax_number": "318-484-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MEDICAL CENTER DR STE 3A",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713018124",
            "telephone_number": "318-484-3899",
            "fax_number": "318-484-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAHID MANSOOR MD, APMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "MANSOOR",
        "authorized_official_first_name": "SHAHID",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "318-484-3899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "13654R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1314579",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1435350",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1161110",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1445215",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, LA

Sources for this page

Verify at the official NPI Registry.