NPIMap

Individual provider Active NPI

Alicia M Mancuso, DO

  • Family Medicine Physician
  • Rockport, ME
National Provider Identifier
1083901078
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO2440 Issued in ME
Practice address
15 Anchor Dr Ste 201
Rockport, ME 04856-3848
Phone
(207) 301-5900
Fax
(207) 301-5358
NPI assigned
Jun 29, 2011
Last updated
Dec 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO2440 ME Primary

Addresses

Primary practice location

15 Anchor Dr Ste 201
Rockport, ME 04856-3848

Mailing address

16 Concourse W
Waterville, ME 04901-6007
Phone (207) 861-1036

Other practice location 1

16 Concourse W
Waterville, ME 04901-6007
Phone (207) 861-1036

Other names 1

  • Alicia M Brown Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140806002538 ME Practitioner - Family PracticePractitioner - Obstetrics/Gynecology 1254599798 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Obstetrics/Gynecology
Education
University of New England, College of Osteo Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

15 Anchor Dr
Rockport, ME 04856-3848

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO2440MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Dec 19, 2023 Accepting new patients
Mainegeneral Medical Center CurrentSince Jul 1, 2014 Accepting new patients
Mainehealth CurrentSince Dec 19, 2023 Accepting new patients
Mainegeneral Medical Center CurrentSince Jul 1, 2014 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth Family Medicine Past Accepting new patients

Locations

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

15 Anchor Dr
Ste 201
Rockport, ME 04856
Phone (207) 301-5800

149 North St
Waterville, ME 04901
Phone (207) 622-1959

Interoperability endpoints

  • Direct secure messaging: amancuso643441@direct.mmc.mainehealth.org

Organizations & group practices 6

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

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1309305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1083901078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 CONCOURSE W",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049016007",
            "telephone_number": "207-861-1036",
            "fax_number": "207-861-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 ANCHOR DR STE 201",
            "city": "ROCKPORT",
            "state": "ME",
            "postal_code": "048563848",
            "telephone_number": "207-301-5900",
            "fax_number": "207-301-5358"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16 Concourse W",
            "address_purpose": "LOCATION",
            "city": "Waterville",
            "state": "ME",
            "postal_code": "049016007",
            "country_code": "US",
            "telephone_number": "207-861-1036",
            "fax_number": "207-861-1039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANCUSO",
        "first_name": "ALICIA",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-29",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "DO2440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "BROWN",
            "middle_name": "M",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rockport, ME

Sources for this page

Verify at the official NPI Registry.