Staci A Mandrola, MD

Primary specialty

Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X

License

41139 Issued in KY

Practice address

7504 Westport Rd
Louisville, KY 40222-4108

Phone

(502) 693-2681

Fax

(502) 456-9738

NPI assigned

May 3, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357862400000",
    "number": "1912129552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 MEADOW RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402052220",
            "telephone_number": "502-456-9738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7504 WESTPORT RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224108",
            "telephone_number": "502-693-2681",
            "fax_number": "502-456-9738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDROLA",
        "first_name": "STACI",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2013-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "KY",
            "license": "41139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000642419",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "3756448000",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100094260",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50026942",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mandala House, LLC
• Anupa Mandava, M.D.
• Lisa M Manderino
• Mandran Health PLLC
• John M Mandrola, MD
• Kyj Roman Mandzy, DO
• Svitlana J Mandzy, M.D.
• Stephanie Manecke
• Erin Lynn Maney
• Richard B Mangan, O.D.

• Hospice and Palliative Medicine (Internal Medicine) Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Hospice and Palliative Medicine (Internal Medicine) Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.