TATIANA MARIE MAMANTOV (MD) – Emergency Medicine Physician, NPI 1629069059
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
29 MEDICAL TOXICOLOGY in CA
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Provider Addresses for TATIANA MARIE MAMANTOV (MD)
Eden Medical Center, 20103, Lake Chabot Road, Castro Valley, Alameda County, California, 94546, United States
CASTRO VALLEY, CA 945465341
Phone: (209) 342-2300
Fax: (209) 524-4240
Type: Location
4301 NORTHSTAR WAY
MODESTO, CA 953569262
Phone: (209) 342-2300
Fax: (209) 524-4240
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-12-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20041217000787 | I | Emergency Medicine | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 23 | 23 | $0 |
Insurance plans in this area (ZIP 94546)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | CA | |
| Family Practice | CA | |
| - | CA | |
| G A S T R O E N T E R O L O G Y | CA | |
| Family Practice | CA | |
| Physical Therapist In Private Practice | CA | |
| - | CA | |
| Orthopedic Surgery, Sports Medicine | NY | |
| Occupational Therapist In Private Practice | CA | |
| Physical Therapist In Private Practice | CA |
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