Organization Active NPI

David W. Mansky,D.P.M.,P.C.

  • Podiatrist
  • Waterford, MI
National Provider Identifier
1053353540
Registry record updated May 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
5901001735 Issued in MI
Legal business name
DAVID W. MANSKY,D.P.M.,P.C.
Practice address
5770 Highland Rd
Suite 3
Waterford, MI 48327-1826
Phone
(248) 674-3124
NPI assigned
Jun 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2008

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

Authorized official

Name
Dr. David W. Mansky, D.P.M.NPI 1407882384
Title
Owner
Phone
(248) 674-3124

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 5901001735 MI Primary

Addresses

Primary practice location

5770 Highland Rd
Suite 3
Waterford, MI 48327-1826

Mailing address

5770 Highland Rd
Suite 3
Waterford, MI 48327-1826
Phone (248) 674-3124

Other identifiers 3

IdentifierTypeStateIssuer
4856351410OtherMIBCBS
3108483OtherMIMOLINA
3108483MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060413000533 MI Part B Supplier - Clinic/Group Practice 2961411228 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Caledonia, MI; Hastings, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1127 W State St
Ste B
Hastings, MI 49058
Phone (269) 945-2222

5770 Highland Rd
Ste 3
Waterford, MI 48327
Phone (248) 674-3124

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1053353540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5770 HIGHLAND RD",
            "address_2": "SUITE 3",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271826",
            "telephone_number": "248-674-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5770 HIGHLAND RD",
            "address_2": "SUITE 3",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271826",
            "telephone_number": "248-674-3124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID W. MANSKY,D.P.M.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "MANSKY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-674-3124",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "5901001735",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4856351410",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "3108483",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3108483",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.