DR. MANGARAJU CHAKKA (NPI# 1104862200) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104862200 |
| Entity Type | Individual |
| Full Name | DR. MANGARAJU CHAKKA |
| Credential | M.D. |
| Practice Address |
10100 Kanis Rd Little Rock AR 72205-6202 |
| Practice Telephone | 5012556000 |
| Practice Fax Number | 5012556400 |
| Mailing Telephone | 5012556000 |
| Mailing Fax Number | 5012556400 |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2011-01-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
E4358 | AR | Allopathic & Osteopathic Physicians |
| Y | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
E4358 | AR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 157168001 | 05 | |
| AR | MALP INS # | 919591 | 01 |
| Street Address |
10100 KANIS RD |
| City | LITTLE ROCK |
| State | AR |
| Zip Code | 72205-6202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073576625 | Yalcin Hacioglu | Internal Medicine | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2006-04-06 |
| 1386279032 | Jenelle Wallis | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2020-03-03 |
| 1831721059 | Keely Sparks | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2020-02-05 |
| 1073078648 | Ashley Allison Long | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2019-02-07 |
| 1144771296 | Kayla Beth Ingram-smith | Clinical Nurse Specialist | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2016-10-24 |
| 1093174716 | Callie Reynolds | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2016-02-23 |
| 1619216496 | Sara Ann Thompson | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2013-02-13 |
| 1811236789 | Leah Brazil | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2013-02-12 |
| 1023381738 | St. Vincent Infirmary Medical Center | Clinic/Center | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2012-02-13 |
| 1679875017 | Abdel Rahman A Al Emam | Internal Medicine | 10100 Kanis Rd, Little Rock, AR 72205 | 2010-11-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932719465 | Darleisha Renee Stigall | Behavior Technician | 1210 Aldersdate Rd, Little Rock, AR 72205 | 2020-08-10 |
| 1316563638 | Unknown Amisha | Student in an Organized Health Care Education/Training Program | 4301 West Markham St, Slot #634, University of Arkansas, Little Rock, AR 72205 | 2020-06-23 |
| 1225667272 | Ann-marie Frances Hayre | Student in an Organized Health Care Education/Training Program | 4310 West Markham, Slot 589, Little Rock, AR 72205 | 2020-04-02 |
| 1952930075 | Alexandria Leigh Smith | Student in an Organized Health Care Education/Training Program | 4301 West Markham St, Slot 531, Little Rock, AR 72205 | 2020-04-02 |
| 1093353922 | Phil Fagala | Pharmacist | 614 North Beechwood, Little Rock, AR 72205 | 2019-12-10 |
| 1295391688 | Home To Community Living, Inc | Physical Therapist | 10201 W Markham Street Pulaski, Little Rock, AR 72205 | 2019-05-12 |
| 1669933693 | Sandy Louise Webb | Student in an Organized Health Care Education/Training Program | 4301 West Markham, Slot 530, Little Rock, AR 72205 | 2019-03-31 |
| 1457812828 | Vincent Battafarano | Student in an Organized Health Care Education/Training Program | 4301 West Markham, Slot 602, Little Rock, AR 72205 | 2019-03-28 |
| 1063978922 | Franks Pediatric Occupational Therapy LLC | Occupational Therapist | 5516 C St, Little Rock, AR 72205 | 2019-02-15 |
| 1497210199 | Integrative Counseling Center LLC | Counselor | 10515 W Markham St Ste D3, Little Rock, AR 72205 | 2019-02-06 |
| Find all providers in zip 72205 | ||||
| Taxonomy Code | 207RC0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Clinical Cardiac Electrophysiology |
| A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194299289 | Mission Properties Group, LLC | Internal Medicine | 11220 Executive Center Dr Ste 200, Little Rock, AR 72211-4492 | 2019-01-11 |
| 1801000476 | Ahmed Abdellatif Hussein | Internal Medicine | 4301 W Markham St, Little Rock, AR 72205-7101 | 2007-05-10 |
| 1295807733 | Thomas Witherspoon Wallace | Internal Medicine | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2006-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639133424 | James Claude Cooper Jr. | Internal Medicine | 38 W. Sunbridge, Va Hospital, Fayetteville, AR 72703 | 2006-04-17 |
| 1205001799 | David Vance | Internal Medicine | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2008-04-25 |
| 1538357470 | Devi Gopinath Nair | Internal Medicine | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2007-10-04 |
| 1396893632 | Jonesboro Ep, LLC | Internal Medicine | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2007-01-05 |
| 1699865857 | Raphael N Ngengwe | Internal Medicine | 201 E Oak Ave, Jonesboro, AR 72401-4163 | 2006-10-16 |
| 1790749638 | Boris V Bogomilov | Internal Medicine | 3211 N Northhills Blvd, Suite 110, Fayetteville, AR 72703-4007 | 2006-04-17 |
| City | LITTLE ROCK |
| Zip Code | 72205 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.