Sebastian R. Mangiamele, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

43323 Issued in MN

Practice address

3801 Bemidji Ave N
Ste 6
Bemidji, MN 56601-4364

Phone

(218) 333-5694

Fax

(218) 444-4728

NPI assigned

Apr 27, 2006

Last updated

Aug 12, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• North Country Medical Clinic

  dba Northern Medical Clinic

  • Clinic/Center
  • Bemidji, MN
  • NPI 1316991334
  NPD (past)
• Physicians Clinic of Minnesota

  • General Practice Physician
  • Bemidji, MN
  • NPI 1033176797
  NPD (past)

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281571200000",
    "number": "1710944475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 BEMIDJI AVE N",
            "address_2": "STE 6",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566014364",
            "telephone_number": "218-333-5694",
            "fax_number": "218-444-4728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 BEMIDJI AVE N",
            "address_2": "STE 6",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566014364",
            "telephone_number": "218-333-5694",
            "fax_number": "218-444-4728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGIAMELE",
        "first_name": "SEBASTIAN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2010-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "43323",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "43323",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MN",
            "license": "43323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "640127900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Serena Jo Madden, MSN, APRN, FNP-C
• James Patrick Madigan, LADC
• Shelly Marie Mahowald, FNP-C
• Jenna Mahs, D.C.
• Mohamed Manaa, MD
• Megan Mansavage, MSW, LICSW, LADC
• Mouhamad Mansour, M.D.
• Amanda Lynn Manteufel, LSW
• Patricia Kay Mapes, PHYSICAL THERAPIST
• Marci L Maple, NP

• General Practice Physician in Bemidji, MN
• Providers in Bemidji, MN by specialty
• General Practice Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.