Haytham Mansour, D.P.M.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

016005301 Issued in IL

Practice address

19255 Everett LN
Suite B
Mokena, IL 60448

Phone

(630) 656-3171

Fax

(630) 657-0131

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

William M. Scholl College of Podiatric Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uchicago Medicine Adventhealth Bolingbrook Hospital, Bolingbrook, IL, CCN 140304
• Macneal Hospital Hospital, Berwyn, IL, CCN 140054

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Hmi Foot and Ankle Group, SC

  • Foot & Ankle Surgery Podiatrist
  • Mokena, IL
  • NPI 1740518307
  Medicare reassignment NPD Authorized official
• Professional Foot & Ankle LLC

  • Podiatrist
  • Park Forest, IL
  • NPI 1467606152
  Medicare reassignment NPD
• PMR Illinois Holding, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1770038671

  IL

  Medicare reassignment NPD
• Yasmin B. Khan, MD PA

  • Obstetrics & Gynecology Physician
  • Richardson, TX
  • NPI 1760777890
  NPD
• Foot and Ankle Inc

  • Primary Podiatric Medicine Podiatrist
  • Homer Glen, IL
  • NPI 1679760821

  Foot & Ankle Surgery

  NPD (past)
• Medical and Foot Care Group

  • Foot & Ankle Surgery Podiatrist
  • Palos HTS, IL
  • NPI 1114106457
  NPD (past)

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

• Adventist Bolingbrook Hospital

  • General Acute Care Hospital
  • Bolingbrook, IL
  • NPI 1164530465
  Care Compare affiliation
• Gottlieb Community Health Services Corporation

  • General Acute Care Hospital
  • Berwyn, IL
  • NPI 1295710580
  Care Compare affiliation

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578614400000",
    "number": "1811078207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 711",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601480711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19255 EVERETT LN",
            "address_2": "SUITE B",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "60448",
            "telephone_number": "630-656-3171",
            "fax_number": "630-657-0131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19255 Everett Ln",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "60448",
            "country_code": "US",
            "telephone_number": "630-656-3171",
            "fax_number": "630-657-0131",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2734 W 87th St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606523937",
            "country_code": "US",
            "telephone_number": "177-391-8470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "HAYTHAM",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IN",
            "license": "07001118A",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00920915",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Te'Aira Marilyn Malone
• Thomas P Maloney, DDS
• Alyson Mangin
• Ashley Mangin, MOS, OTR/L
• Shannon Mannix, LCSW
• Manuel Perez, M.D.,S.C.
• Sheila Marie Mara, FNP
• Kara Marcus, MS CCC-SLP
• Marley Oaks Assisted Living Residence
• Marquette Eye and Vision Center, LLC

• Foot & Ankle Surgery Podiatrist in Mokena, IL
• Providers in Mokena, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.