Shiva Mansourkhani, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

P5417 Issued in TX

Practice address

800 N Mesa St
El Paso, TX 79902

Phone

(915) 215-6170

Fax

(915) 215-8659

NPI assigned

Jul 1, 2009

Last updated

Feb 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Psychiatry

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Psychiatry

  Medicare reassignment Care Compare group NPD
• Health and Human Services Commission

  dba Rio Grande State Center

  • Clinical Neuropsychologist
  • Harlingen, TX
  • NPI 1356414692

  Psychiatry

  Medicare reassignment NPD
• Texas Tech University Health Sciences Center El Paso

  • Internal Medicine Physician
  • El Paso, TX
  • NPI 1598705055
  Medicare reassignment NPD
• Health and Human Services Commission

  dba Big Spring State Hospital

  • Psychiatric Hospital
  • Big Spring, TX
  • NPI 1881600682
  NPD
• Texas Tech University Health Sciences Center El Paso

  dba Texas Tech Univesity Health Sciences Center Neuropsychiatry

  • Psychiatry Physician
  • El Paso, TX
  • NPI 1124047295
  NPD
• Texas Tech University Health Sciences Center El Paso

  • Neurological Surgery Physician
  • El Paso, TX
  • NPI 1457913444
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1922236603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 RAYNOLDS ST DEPT OF",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799051613",
            "telephone_number": "915-215-4480",
            "fax_number": "915-215-5386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N MESA ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79902",
            "telephone_number": "915-215-6170",
            "fax_number": "915-215-8659"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 Alberta Avenue",
            "address_2": "Department of Psychiatry",
            "address_purpose": "LOCATION",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79905",
            "country_code": "US",
            "telephone_number": "915-587-6516",
            "fax_number": "915-587-6517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSOURKHANI",
        "first_name": "SHIVA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-01",
        "last_updated": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "P5417",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "P5417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1200 El Camino Real",
            "city": "South San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "94080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bertha Manriquez, MS, CCC-SLP
• Gage Elise Manriquez, DPT
• Matthew Manriquez, LMT
• David J Mansfield, MD
• Gabriel Mansouraty, MD
• Manual Physical Therapy Specialists LLC
• Manuel D Lopez MD PA
• Manuel F Valenzuela Mdpa
• Manuel J. Palafox, D.O., P.a
• Zachary Daniel Manzo-Micoletti, PA-C

• Child & Adolescent Psychiatry Physician in El Paso, TX
• Providers in El Paso, TX by specialty
• Child & Adolescent Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.