Timothy Wayne Mansouri, NURSE PRACTITIONER

Primary specialty

Pain Management Registered NurseTaxonomy code 163WP0000X

License

95003073 Issued in CA

Practice address

1600 Creekside Dr Ste 2400
Folsom, CA 95630-3485

Phone

(916) 932-4163

NPI assigned

Apr 16, 2015

Sex

Male

Sole proprietor

Yes

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.

• Advanced Pain Diagnostic & Solutions, Inc.

  • Pain Clinic/Center
  • Roseville, CA
  • NPI 1427322635

  CA, Single Specialty

  Medicare reassignment Care Compare group NPD
• Bingtao Lin, MD, PC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Roseville, CA
  • NPI 1750865358

  CA, Single Specialty

  Medicare reassignment NPD

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Pain Diagnostic and Solutions Inc 20 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: timothy.mansouri.p1@direct.apdss.nextgenshare.com

• Tim Mansouri Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 3, 2020.

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1770970899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8732 FLUTE CIR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957571742",
            "telephone_number": "209-765-8297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 CREEKSIDE DR STE 2400",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303485",
            "telephone_number": "916-932-4163"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1665 Creekside Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Folsom",
            "state": "CA",
            "postal_code": "956303538",
            "country_code": "US",
            "telephone_number": "916-932-4163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSOURI",
        "first_name": "TIMOTHY",
        "middle_name": "WAYNE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-16",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Pain Management",
            "state": "CA",
            "license": "656576",
            "primary": false
        },
        {
            "code": "163WP0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pain Management",
            "state": "CA",
            "license": "95003073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIM",
            "last_name": "MANSOURI",
            "credential": "NURSE PRACTITIONER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sonia Mann, PH.D.
• Indrani Manne, DDS
• Brittaney Elaine Manocchio
• Leah Mansfield, BCBA
• Linda M Mansker, CRNA
• Mantena Dental Corportation
• Rakesh Mantena, DDS
• Mavis Manthe
• Wendi Manuele, PHARM D
• Roger Mar-Tang, M.D.

• All providers in Folsom, CA
• Pain Management Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; 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.
• 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.