KATHERINE ANN MANDEVILLE MD
NPI 1649355397
Pediatrics - Pediatric Emergency Medicine in San Diego, CA
About Katherine Ann Mandeville Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KATHERINE ANN MANDEVILLE MD (NPI 1649355397) is an individual pediatric emergency medicine provider in San Diego, California, licensed in California (C149595) and active in the NPI registry since October 2006. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Katherine Ann Mandeville Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Katherine Mandeville reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
San Diego, CA 92123
- Reassigned Medicare billing, California enrollment
- 562 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAN DIEGO, CA 92123
SAN DIEGO, CA 92123
SAN DIEGO, CA 92123
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Katherine Mandeville's NPI number?
The NPI number for Katherine Mandeville is 1649355397. It was assigned to this individual provider in the NPPES registry on October 25, 2006.
Where is Katherine Mandeville located?
Katherine Mandeville practices at 3020 Childrens Way, San Diego, CA 92123. The listed phone number is (858) 966-8036.
What is Katherine Mandeville's specialty?
The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Emergency Medicine, with taxonomy code 2080P0204X.
Is Katherine Mandeville enrolled in Medicare?
Yes. Katherine Mandeville is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Katherine Mandeville's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Katherine Mandeville reassigns Medicare benefits to Rady Children's Hospital San Diego (San Diego, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Katherine Mandeville's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Katherine Mandeville was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Katherine Ann Mandeville, MD · NPI 1649355397
Pediatric Emergency Medicine physician in San Diego, California. Individual provider, active in the CMS NPPES registry since October 25, 2006.
## Identity
- **NPI:** 1649355397 (Entity type: Individual)
- **Enumerated:** October 25, 2006
- **Primary specialty:** Pediatrics - Pediatric Emergency Medicine · taxonomy 2080P0204X
- **State license:** C149595 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 3020 CHILDRENS WAY, San Diego, CA 92123-4223
- **Phone:** (858) 966-8036 · **Fax:** (858) 966-7433
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Rady Children's Hospital San Diego (NPI 1669617197, San Diego, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 21, 2022
- **Other identifiers:** Medicaid 22807349 (CO)
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Source: [NPI Profile](https://npiprofile.com/npi/1649355397) · Data from the CMS NPPES public registry.