NPI Details
DR. Michael E Mandis, MD is an internal medicine in Maryville, IL with 36 years of experience. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. DR. Michael E Mandis, MD NPI is 1821065764. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
2236 VADALABENE DR
SUITE 2
MARYVILLE, IL
ZIP 62062-844
Phone: (618) 288-6136
Fax: (618) 288-6143
The NPI 1821065764 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.
The CLIA number assigned to this NPI record is 14D1039929 - physician office with a certificate type of Certificate of Waiver.
The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.
- Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
- Emergency department visit for life threatening or functioning severity (HCPCS:99285)
- Emergency department visit for problem of high severity (HCPCS:99284)
- Emergency department visit for problem of moderate severity (HCPCS:99283)
- Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
- New patient office or other outpatient visit, 45-59 minutes (HCPCS:99204)
The enumeration date for this NPI number is 2/28/2006 and was last updated on 3/31/2020.
Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207P00000X | Emergency Medicine | | 036112094 | ILLINOIS | No |
| 2 | 207R00000X | Internal Medicine | | 036112094 | ILLINOIS | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 036112094 | MEDICAID | ILLINOIS | |
| 2 | 202790173 | OTHER | | TRICARE |
| 3 | 241366 | OTHER | | GHP |
| 4 | 7496677 | OTHER | | AETNA |
| 5 | I23797 | OTHER | | MERCY |
| 6 | 036112094-3 | MEDICAID | ILLINOIS | |
| 7 | 06032146 | OTHER | ILLINOIS | BLUE CROSS ILLINOIS |
| 8 | 036112094-5 | MEDICAID | ILLINOIS | |
| 9 | 199147 | OTHER | MISSOURI | BLUE SHIELD MO |
| 10 | 701184 | OTHER | | HEALTHLINK |
| 11 | P00265571 | OTHER | | MEDICARE RAILROAD |
| 12 | 1821065764 | MEDICAID | MISSOURI | |
