Active NPI
Mark Manzo
- Physician Assistant
- Worcester, MA
National Provider Identifier
1003042441
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Oct 20, 2016.
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA3715
- Practice address
- 210 Park Ave Ste 163
Worcester, MA 01609-2246 - Phone
- (508) 752-0843
- NPI assigned
- May 29, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA3715 | MA | Primary |
Addresses
Primary practice location
210 Park Ave Ste 163
Worcester, MA 01609-2246
Mailing address
210 Park Ave Ste 163
Worcester, MA 01609-2246
Phone (508) 752-0843
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9773312 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447977600000",
"number": "1003042441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 PARK AVE STE 163",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016092246",
"telephone_number": "508-752-0843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 PARK AVE STE 163",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016092246",
"telephone_number": "508-752-0843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANZO",
"first_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-29",
"last_updated": "2015-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "PA3715",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9773312",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.