Lydia Rose Mangan, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

10002502A Issued in IN

Practice address

8402 Harcourt Rd Ste 100
Indianapolis, IN 46260

Phone

(317) 338-7674

NPI assigned

Jul 26, 2018

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lydia.renken.1@7598.direct.athenahealth.com

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.

• St Vincent Pediatric Subspecialties

  • Pediatrics Physician
  • Indianapolis, IN
  • NPI 1013967736
  Medicare reassignment
• St Vincent Pediatric Subspecialties

  • Pediatric Critical Care Medicine Physician
  • Evansville, IN
  • NPI 1851950224
  NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1992282511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46260",
            "telephone_number": "317-338-7674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGAN",
        "first_name": "LYDIA",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-26",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10002502A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lydia.renken.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St Vincent Pediatric Subspecialties",
            "address_1": "8402 Harcourt Rd Ste 100",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Aaron Matthew Mang, DO
• Sarah Bawi Tin Cuai Mang
• Varun Mangal
• Kapil Nitin Mangaldas
• Emory Anna Mangan, PA-C
• Mangas Chiropractic
• Mangas Chiropractic and Acupuncture P.C.
• Steven C. Mangas, D.C.
• Joanna Manghelli, D.O
• Joshua Lee Manghelli, D.O.

• Medical Physician Assistant in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Medical Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.