Alay Mansurov, M.D.

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

72453-20 Issued in WI

Practice address

908 W 4TH North St
Morristown, TN 37814-3894

Phone

(423) 492-6100

NPI assigned

Jul 8, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI, TN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Medical Oncology

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thompson Oncology GroupGroup PAC ID 0941246771, 65 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Morristown Hamblen Hospital Association Hospital, Morristown, TN, CCN 440030
• Fort Sanders Regional Medical Center Hospital, Knoxville, TN, CCN 440125

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amansurov295718@direct.thedacare.org
• Direct secure messaging: mansurov.alay@covenanthealth.cernerdirect.com

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.

• Thompson Oncology Group

  • Hematology & Oncology Physician
  • Knoxville, TN
  • NPI 1619975737
  Medicare reassignment Care Compare group NPD
• Bellin Memorial Hospital Inc

  • Rural Health Clinic/Center
  • Algoma, WI
  • NPI 1609838473
  Medicare reassignment NPD
• Oconto Hospital & Medical Center Inc

  • Critical Access Hospital
  • Oconto, WI
  • NPI 1356373302
  Medicare reassignment NPD
• Bellin Memorial Hospital

  • General Practice Physician
  • Green Bay, WI
  • NPI 1629260625
  NPD
• Bellin Memorial Hospital Inc

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390

  Internal Medicine

  NPD
• Oconto Hospital & Medical Center Inc

  • Rural Health Clinic/Center
  • Suring, WI
  • NPI 1104418037
  NPD
• Oconto Hospital & Medical Center Inc

  • Rural Health Clinic/Center
  • Lakewood, WI
  • NPI 1790284438
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fort Sanders Regional Medical Center

  • General Acute Care Hospital
  • Knoxville, TN
  • NPI 1942294814
  Care Compare affiliation
• Morristown Hamblen Hospital Association

  • General Acute Care Hospital
  • Morristown, TN
  • NPI 1912997024
  Care Compare affiliation

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

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1033592035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 W 4TH NORTH ST",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378143894",
            "telephone_number": "423-492-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 W 4TH NORTH ST",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378143894",
            "telephone_number": "423-492-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2820 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433834",
            "country_code": "US",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1580 Commanche Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543135751",
            "country_code": "US",
            "telephone_number": "920-435-8326",
            "fax_number": "920-430-4659",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "744 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013505",
            "country_code": "US",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "836 W Wellington Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606575147",
            "country_code": "US",
            "telephone_number": "312-731-8440",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 Arbutus Ave",
            "address_purpose": "LOCATION",
            "city": "Oconto",
            "state": "WI",
            "postal_code": "541532004",
            "country_code": "US",
            "telephone_number": "920-834-1100",
            "fax_number": "920-835-1099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSUROV",
        "first_name": "ALAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-08",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.067089",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WI",
            "license": "72453-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q043373",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN BOARD OF INTERNAL MEDICINE/HEMATOLOGY AND ONCOLOGY",
            "identifier": "389016",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mansurov.alay@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "908 W 4th North St",
            "city": "Morristown",
            "state": "TN",
            "country_code": "US",
            "postal_code": "378143894",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Olga Mallicoat, FNP
• Sierra Jean Malone
• Cedrick Manalili, PHYSICAL THERAPIST
• Irene Pacia Manalili, PHYSICAL THERAPIST
• Casey Manning, A.S., CNA
• Cynthia Diane Mantooth, APRN
• Victor Manzo Jr., DC
• Siva Maran, M.D.
• Brielle Joy Denae Marshall
• Martha M Masters

• Hematology & Oncology Physician in Morristown, TN
• Providers in Morristown, TN by specialty
• Hematology & Oncology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; 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.