Jessica Colleen Mangonon, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A128287 Issued in CA

Practice address

16300 Sand Canyon Ave
#811
Irvine, CA 92618-3711

Phone

(949) 753-9000

Fax

(949) 753-5044

NPI assigned

Apr 13, 2012

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

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10944/brand/3/csg/1/fhir/r4
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Hoag Clinic

  • Primary Care Clinic/Center
  • Newport Beach, CA
  • NPI 1942799523
  Medicare reassignment NPD
• University of California Irvine

  • Federally Qualified Health Center (FQHC)
  • Anaheim, CA
  • NPI 1598790529
  Medicare reassignment NPD
• University of California Irvine

  • Pharmacy
  • Irvine, CA
  • NPI 1669344339
  NPD
• Hoag Hospital

  • General Acute Care Hospital
  • Newport Beach, CA
  • NPI 1689864365
  NPD (past)
• University of California Irvine

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1689608150
  NPD (past)

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

{
    "created_epoch": "1334275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496275200000",
    "number": "1962769968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16300 SAND CANYON AVE",
            "address_2": "#811",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183711",
            "telephone_number": "949-753-9000",
            "fax_number": "949-753-5044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16300 SAND CANYON AVE",
            "address_2": "#811",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183711",
            "telephone_number": "949-753-9000",
            "fax_number": "949-753-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGONON",
        "first_name": "JESSICA",
        "middle_name": "COLLEEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-13",
        "last_updated": "2017-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A128287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Manalili, DDS
• Brian Manas, D.C.
• Laura Corinne Mandich, PT, DPT
• Fatima Manesh, ALC
• Aishwarya Manga
• Tamara Mangum, B.S. OCCUPATIONAL TH
• Chirag Mani
• Greta G. Manila, NP
• Jessina Marie Manio (Stedman Is Maiden), ATC
• Olivia Maniuc

• Pediatrics Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.