Jorge Mantilla, SA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

238.000655 Issued in IL

Practice address

5540 N Kimball Ave Apt 3E
Chicago, IL 60625-4674

Phone

(312) 983-0540

NPI assigned

Apr 18, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581379200000",
    "number": "1962065516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5540 N KIMBALL AVE APT 3E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254674",
            "telephone_number": "312-983-0540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5540 N KIMBALL AVE APT 3E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254674",
            "telephone_number": "312-983-0540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTILLA",
        "first_name": "JORGE",
        "credential": "SA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-18",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TX",
            "license": "19-180",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "238.000655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Mansuri, M.D.
• Cristina Manta, M.D.
• Mantality Illinois LLC
• Jenna Mantell, LCSW
• Marlene Mantich, D.P.M.
• Stelios Mantis, MD
• Wendy L. Manto, M.A., L.C.P.C.
• Manuel a Franco SC
• Manuel Burciaga Martinez M.D.S.C.
• Manuel Montes de Oca MD PC

• Surgical Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; 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.