NPIMap

Individual provider Active NPI

Marcelo J. Mantala, MD

  • Internal Medicine Physician
  • Springfield, MO
National Provider Identifier
1710089644
Registry record updated May 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
116600 Issued in MO
Practice address
1235 E Cherokee St
Springfield, MO 65804-2203
Phone
(417) 820-2600
Fax
(417) 820-2100
NPI assigned
Sep 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 116600 MO Primary

Addresses

Primary practice location

1235 E Cherokee St
Springfield, MO 65804-2203

Mailing address

PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620

Other identifiers 1

IdentifierTypeStateIssuer
203830617MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20070227000276 MO Practitioner - Internal Medicine 8022110709 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, 1,121 clinicians

Practice addresses (Care Compare)

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

3231 S National Ave
Springfield, MO 65807-7304

Hospital & facility affiliations

  • Phoenix Home Care and Hospice Hospice, Springfield, MO, CCN 261667
  • Preferred Hospice of Missouri (Southwest), LLC Hospice, Ozark, MO, CCN 261635
  • Regional Hospice Hospice, Springfield, MO, CCN 261578
  • St Croix Hospice Hospice, Bolivar, MO, CCN 261630
  • Gentiva Hospice, Joplin, MO, CCN 261585
  • Ozarks Community Hospital of Gravette Hospital, Gravette, AR, CCN 041331
  • Mercy Hospital Springfield Hospital, Springfield, MO, CCN 260065
  • Spring Valley Health & Rehabilitation Center Nursing home, Springfield, MO, CCN 265188
  • Neighborhoods at Quail Creek, the Nursing home, Springfield, MO, CCN 265799
  • Maples Health and Rehabilitation, the Nursing home, Springfield, MO, CCN 265559
  • Springfield Rehabilitation & Health Care Center Nursing home, Springfield, MO, CCN 265157
  • Maranatha Village, Inc Nursing home, Springfield, MO, CCN 265475

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities Internal Medicine CurrentSince Aug 11, 2003 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Aug 11, 2003 Accepting new patients
Select Specialty Hospital Springfield Inc CurrentSince Apr 5, 2011 Accepting new patients
Select Specialty Hospital Springfield Inc CurrentSince Apr 5, 2011 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 4, 2007 Accepting new patients
MC Fremont Healthcare, LLC Past Accepting new patients
NHC Healthcare-Springfield Missouri LLC Past Accepting new patients
N & R of Brookhaven LLC Past Accepting new patients
Ozarks Medical Center Past Accepting new patients
N & R of Springfield West LLC Past Accepting new patients
N & R of Springfield East LLC Past Accepting new patients
Greeneco NC Ops, Inc. Past Accepting new patients
R H Montgomery Properties, Inc Past Accepting new patients
N & R of Springfield Montclair LLC Past Accepting new patients

Locations

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

1630 E Primrose St
Springfield, MO 65804
Phone (417) 885-4700

1514 W Lark St
Springfield, MO 65810
Phone (417) 631-2303

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

620 S Glenstone Ave
Springfield, MO 65802
Phone (417) 829-4215

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Maples Health and RehabilitationSpringfield, MO, CCN 265559 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 15, 2020
Dec 15, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367884800000",
    "number": "1710089644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2580",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658012580",
            "telephone_number": "417-829-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 E CHEROKEE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042203",
            "telephone_number": "417-820-2600",
            "fax_number": "417-820-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTALA",
        "first_name": "MARCELO",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2013-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "116600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203830617",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.