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JONATHAN EDWARD MANDABACH M.D.
NPI 1912386392
Pediatrics in Tucson, AZ

Active since May 19, 2015PECOS Enrolled
4175 S ALAMO AVE BLDG 400, TUCSON, AZ 85707(520) 228-2700 Get Directions Write a Review

NPPES record last updated: January 3, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Jonathan Edward Mandabach M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JONATHAN EDWARD MANDABACH M.D. (NPI 1912386392) is an individual pediatrics provider in Tucson, Arizona, licensed in Hawaii (MD-19773) and active in the NPI registry since May 2015. He is enrolled in Medicare PECOS and maintains a secondary practice location in Honolulu.

NPPES Registry Identity

NPI1912386392
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameJONATHAN EDWARD MANDABACHCredential: M.D.
Location Address4175 S ALAMO AVE BLDG 400Tucson, AZ 85707
Mailing Address1319 Punahou StHonolulu, HI 96826-1001 · (808) 369-1265 · Fax (808) 369-1212
Phone(520) 228-2700
Sole ProprietorNo
Enumeration DateMay 19, 2015
Last NPPES UpdateJanuary 3, 2019
✔ NPI 1912386392 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in HI · MD-19773
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
4175 S ALAMO AVE BLDG 400, Tucson, AZ 85707
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Secondary Practice Location 1

Location 11319 Punahou StHonolulu, HI 96826-1001 · Phone (808) 369-1200 · Fax (808) 369-1212

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jonathan Edward Mandabach M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jonathan Mandabach reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Banner Physician Super Specialists Arizona LLC
83 mi
Multi-Specialty
37100 N GANTZEL RD STE 214
San Tan Valley, AZ 85140
  • Reassigned Medicare billing, Arizona enrollment
  • 188 clinicians in this Medicare group
NPI 1396014403 (480) 412-9400

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 85707 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ASHLEY RAYE ROTH DMD
Dentist (General Practice)
4175 S ALAMO AVE BLDG 400
TUCSON, AZ 85707
Pima County (520) 228-1907
JOHN PATRICK MORAN M.D.
Family Medicine
4175 S ALAMO AVE BLDG 400, 355 MEDICAL GROUP
DAVIS MONTHAN AFB, AZ 85707
Pima County (520) 584-1185
DR. DEREK SNARE D.M.D.
Dentist (General Practice)
4175 S ALAMO AVE BLDG 400
DAVIS MONTHAN AFB, AZ 85707
Pima County (520) 228-1559
JUSTIN CHIASSON IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
4175 S ALAMO AVE BLDG 400
DAVIS MONTHAN AFB, AZ 85707
Pima County (626) 715-8203
MARISOL VALDIVIA-MIER PHARMD
Pharmacist
4175 S ALAMO AVE BLDG 400
DAVIS MONTHAN AFB, AZ 85707
Pima County (520) 228-1923

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 Jonathan Mandabach's NPI number?

The NPI number for Jonathan Mandabach is 1912386392. It was assigned to this individual provider in the NPPES registry on May 19, 2015.

Where is Jonathan Mandabach located?

Jonathan Mandabach practices at 4175 S Alamo Ave Bldg 400, Tucson, AZ 85707. The listed phone number is (520) 228-2700.

What is Jonathan Mandabach's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Jonathan Mandabach enrolled in Medicare?

Yes. Jonathan Mandabach is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jonathan Mandabach's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jonathan Mandabach reassigns Medicare benefits to Banner Physician Super Specialists Arizona LLC (San Tan Valley, AZ). 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 Jonathan Mandabach'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 Jonathan Mandabach was last updated on January 3, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.