DR. SHANTAE MANGAROO M.D.
NPI 1902293434
Family Medicine in Lithonia, GA
About Dr. Shantae Mangaroo M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. SHANTAE MANGAROO M.D. (NPI 1902293434) is an individual family medicine provider in Lithonia, Georgia, licensed in Georgia (80684) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS, maintains a secondary practice location in Atlanta, and is a graduate of Morehouse School Of Medicine (2014).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Shantae Mangaroo M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Shantae Mangaroo reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Atlanta, GA 30305
- Reassigned Medicare billing, Georgia enrollment
- 1,389 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30038 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LITHONIA, GA 30038
LITHONIA, GA 30038
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 Shantae Mangaroo's NPI number?
The NPI number for Shantae Mangaroo is 1902293434. It was assigned to this individual provider in the NPPES registry on April 22, 2015.
Where is Shantae Mangaroo located?
Shantae Mangaroo practices at 8011 Mall Pkwy, Lithonia, GA 30038. The listed phone number is (404) 518-8056.
What is Shantae Mangaroo's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Shantae Mangaroo enrolled in Medicare?
Yes. Shantae Mangaroo is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Shantae Mangaroo's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shantae Mangaroo reassigns Medicare benefits to The Southeast Permanente Medical Group (Atlanta, GA). 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 Shantae Mangaroo'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 Shantae Mangaroo was last updated on April 14, 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.
# Dr. Shantae Mangaroo, M.D. · NPI 1902293434
Family Medicine physician in Lithonia, Georgia. Individual provider, active in the CMS NPPES registry since April 22, 2015.
## Identity
- **NPI:** 1902293434 (Entity type: Individual)
- **Enumerated:** April 22, 2015
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 80684 (Georgia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 8011 MALL PKWY, Lithonia, GA 30038
- **Phone:** (404) 518-8056
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** The Southeast Permanente Medical Group (NPI 1245266956, Atlanta, GA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Morehouse School Of Medicine, class of 2014
## Record status
- **NPPES last updated:** April 14, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1902293434) · Data from the CMS NPPES public registry.