Kelsey Marie Manescalco, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3513 Issued in MN

Practice address

15704 90TH St NE # 100
Otsego, MN 55330-7448

Phone

(763) 241-1090

NPI assigned

Jul 10, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Kelsey Marie Westbrook Former name

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• SSM Health Care Group

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1306589544
  Medicare reassignment Care Compare group NPD
• Mercy Hospitals East Communities

  • Clinic/Center
  • Saint Louis, MO
  • NPI 1851431738
  Medicare reassignment NPD
• Mercy Hospitals East Communities

  • Land Ambulance
  • Saint Louis, MO
  • NPI 1881329902
  NPD
• SSM Health Care Group

  • Dermatopathology Physician
  • Saint Louis, MO
  • NPI 1932844495
  NPD
• Bright Eyes Vision Clinic, PA

  • Optometrist
  • Otsego, MN
  • NPI 1720113947
  NPD (past)
• SSM Medical Group Inc.

  • Durable Medical Equipment & Medical Supplies
  • Fenton, MO
  • NPI 1124579966
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499644800000",
    "number": "1003338211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15704 90TH ST NE # 100",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553307448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15704 90TH ST NE # 100",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553307448",
            "telephone_number": "763-241-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANESCALCO",
        "first_name": "KELSEY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-10",
        "last_updated": "2017-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "MN",
            "license": "3513",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "MN",
            "license": "3513",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MN",
            "license": "3513",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "WESTBROOK",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Luxottica of America Inc.
• Kayla A Mackedanz
• Tomi Majerus, LMFT
• Megan Majsterski Lazere
• Arilewo Rachael Makinde
• Sandra Louis Mangle, MA, LAMFT
• Nicole Martinson
• Mikki K Mason, LMFT, LADC
• Megan Cole Matteson, COTA/L
• Chad Jeffrey Mattila, D.C.

• Optometrist in Otsego, MN
• Providers in Otsego, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.