Individual provider Active NPI

Loris N Mansour, M.D.

  • Internal Medicine Physician
  • Sarasota, FL
National Provider Identifier
1710917653
Registry record updated Feb 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME138977 Issued in FL
Practice address
1515 S Osprey Ave Ste A1
Sarasota, FL 34239-2933
Phone
(941) 917-7197
Fax
(941) 917-4016
NPI assigned
Jul 4, 2006
Last updated
Feb 15, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA07927200 NJ
Internal Medicine Physician 207R00000X ME138977 FL Primary

Addresses

Primary practice location

1515 S Osprey Ave Ste A1
Sarasota, FL 34239-2933

Mailing address

PO Box 863407
Orlando, FL 32886-3407
Phone (941) 917-2600

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20190313002766 FL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 3971602913 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SMH Physician Services IncGroup PAC ID 1355240177, 781 clinicians

Practice addresses (Care Compare)

1515 S Osprey
Suite 1 a
Sarasota, FL 34239-2933
Phone (941) 917-7197

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME138977FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SMH Physician Services Inc Internal Medicine CurrentSince Apr 22, 2019 Accepting new patients
SMH Physician Services Inc PastSince Apr 22, 2019 Accepting new patients
Escales Medical Associates at Wayne LLC PastSince Apr 11, 2021 Accepting new patients

Locations

1515 S Osprey Ave
Ste A1
Sarasota, FL 34239
Phone (941) 917-7197

1921 Waldemere St
Ste 307
Sarasota, FL 34239
Phone (941) 917-8565

Interoperability endpoints

  • Direct secure messaging: loris.mansour@fpg.directbygreenway.com

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550188800000",
    "number": "1710917653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 863407",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328863407",
            "telephone_number": "941-917-2600",
            "fax_number": "941-917-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 S OSPREY AVE STE A1",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342392933",
            "telephone_number": "941-917-7197",
            "fax_number": "941-917-4016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "LORIS",
        "middle_name": "N",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2019-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07927200",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME138977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sarasota, FL

Sources for this page

Verify at the official NPI Registry.