NPIMap

Individual provider Active NPI

Sidney Shane Mangelsdorf, AG-ACNP

  • Acute Care Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1871950980
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP8394 Issued in AZ
Practice address
500 W Thomas Rd Ste 400
Phoenix, AZ 85013-4238
Phone
(602) 406-3874
Fax
(602) 406-2335
NPI assigned
Jan 20, 2016
Last updated
Jun 8, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP8394 AZ Primary
Adult Health Nurse Practitioner 363LA2200X AP8394 AZ
Gerontology Nurse Practitioner 363LG0600X AP8394 AZ

Addresses

Primary practice location

500 W Thomas Rd Ste 400
Phoenix, AZ 85013-4238

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170728002543 AZ Practitioner - Nurse Practitioner 7810268521 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Joseph's Hospital and Medical CenterGroup PAC ID 6709863178, 23 clinicians

Practice addresses (Care Compare)

350 W Thomas Rd
Phoenix, AZ 85013-4409
Phone (602) 406-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Hospital and Medical Center CurrentSince Dec 17, 2018 Accepting new patients
St Josephs Pathology Current Accepting new patients
Affiliated Hospitalists, PLC Internal Medicine CurrentSince Jun 1, 2023 Accepting new patients
Sjhmc Physician Services CurrentSince May 22, 2017 Accepting new patients
Leading Health Managed Care, LLC Internal Medicine CurrentSince Jul 4, 2021 Accepting new patients
Dignity Health PastSince Jul 25, 2019 Accepting new patients
Renewcare of Scottsdale, Inc. Past Accepting new patients

Locations

1955 W Frye Rd
Chandler, AZ 85224
Phone (480) 507-2961

16640 N 38th St
Phoenix, AZ 85032
Phone (602) 482-6671

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

500 W Thomas Rd
Ste 400
Phoenix, AZ 85013
Phone (602) 406-3874

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

9225 N 3rd St
Ste 300
Phoenix, AZ 85020
Phone (602) 870-1821

File 56765
Los Angeles, CA 90074

Organizations & group practices 8

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": "1453248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780876800000",
    "number": "1871950980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134238",
            "telephone_number": "602-406-3874",
            "fax_number": "602-406-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGELSDORF",
        "first_name": "SIDNEY",
        "middle_name": "SHANE",
        "credential": "AG-ACNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-20",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "AP8394",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AZ",
            "license": "AP8394",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "AP8394",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.