Alicia Mangram, MD

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

License

45385 Issued in AZ

Practice address

16601 N 40TH St Ste 204
Phoenix, AZ 85032-3356

Phone

(602) 633-3721

Fax

(602) 595-1127

NPI assigned

Feb 7, 2006

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 2

Medicare fee-for-service enrollment

Enrolled in AZ

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amangram633843@direct.ochin.org
• Direct secure messaging: aliciamangram@vsc.allscriptsdirect.net

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.

• Honorhealth

  • Surgery Physician
  • Scottsdale, AZ
  • NPI 1801092564
  Medicare reassignment NPD
• CCST Associates PLLC

  • Specialist
  • Dallas, TX
  • NPI 1023117157
  NPD Authorized official
• Acute Care Surgical Specialists, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Phoenix, AZ
  • NPI 1225311871
  Medicare reassignment
• Honorhealth

  • Prosthetic/Orthotic Supplier
  • Peoria, AZ
  • NPI 1386456762
  NPD
• Valley Surgical Clinics, LTD

  • Surgery Physician
  • Phoenix, AZ
  • NPI 1962440602
  NPD
• Associates in Surgical Acute Care

  • Trauma Surgery Physician
  • Dallas, TX
  • NPI 1730345208
  NPD
• Physician Associates of Southwest Dallas

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1801845425

  Surgery

  NPD (past)

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1972575504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16601 N 40TH ST STE 204",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323356",
            "telephone_number": "602-633-3721",
            "fax_number": "602-595-1127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16601 N 40TH ST STE 204",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323356",
            "telephone_number": "602-633-3721",
            "fax_number": "602-595-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGRAM",
        "first_name": "ALICIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-07",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "AZ",
            "license": "45385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "665273",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144729405",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Mangold, AU.D.
• Mary Lynn Mangold, PT
• Bernard Albert Mangone, D.V.M.
• Elizabeth Ann Mangone, MD, MPH
• Joseph Dominic Mangone, D.O., M.P.H.
• Jacqueline S Mangrum, LPN
• Michael Ross Mangum
• Tara Mangum, D.O.
• Erin Maniaci, PT, DPT
• Tracey Denise Manigault, MA., CSP

• Surgical Critical Care Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Surgical Critical Care Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; 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.