Organization Active NPI

Mental Wellness Group PLLC

  • Psychiatry Physician
  • Roanoke, VA
National Provider Identifier
1760860936
Registry record updated Sep 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MENTAL WELLNESS GROUP PLLC
Practice address
3959 Electric Rd Ste 280
Roanoke, VA 24018-4572
Phone
(540) 427-7944
Fax
(540) 427-7945
NPI assigned
May 8, 2015
Last updated
Sep 23, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2018

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

Authorized official

Name
Dr. Malak Iskandar, D.O.NPI 1841581295
Title
Owner
Phone
(540) 427-7944

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3959 Electric Rd Ste 280
Roanoke, VA 24018-4572

Mailing address

PO Box 20867
Roanoke, VA 24018-0526
Phone (540) 427-7944

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150904001560 VA Part B Supplier - Clinic/Group Practice 8729394762 Receives reassigned benefits from 3 practitioners
Practice locations: Roanoke, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2127907Mental Wellness Group, PLLC3959 Electric Road - Suite 280, Roanoke, VA 24018Certificate of waiverMar 20, 2027

National Provider Directory

National Provider Directory

Locations

3959 Electric Rd
Ste 280
Roanoke, VA 24018
Phone (540) 427-7944

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537660800000",
    "number": "1760860936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20867",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240180526",
            "telephone_number": "540-427-7944",
            "fax_number": "540-427-7945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3959 ELECTRIC RD STE 280",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184572",
            "telephone_number": "540-427-7944",
            "fax_number": "540-427-7945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL WELLNESS GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-08",
        "last_updated": "2018-09-23",
        "status": "A",
        "authorized_official_last_name": "ISKANDAR",
        "authorized_official_first_name": "MALAK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-427-7944",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.