NPIMap

Organization Active NPI

Dawn B Mancuso, MD, LLC

Doing business as Heritage Family Medicine

  • Family Medicine Physician
  • Madison, AL
National Provider Identifier
1114141744
Registry record updated Dec 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
00015990 Issued in AL
Legal business name
DAWN B MANCUSO, MD, LLC
Doing business as
Heritage Family Medicine
Practice address
12205 County Line Rd
Suite B
Madison, AL 35758-7719
Phone
(256) 990-8446
Fax
(256) 461-0393
NPI assigned
Apr 13, 2007
Last updated
Dec 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2018

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

Authorized official

Name
Mr. Anthony G Mancuso
Title
Cfo
Phone
(256) 990-8446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 00015990 AL Primary

Addresses

Primary practice location

12205 County Line Rd
Suite B
Madison, AL 35758-7719

Mailing address

PO Box 617
Madison, AL 35758-0617
Phone (256) 990-8446

Other identifiers 2

IdentifierTypeStateIssuer
529910550MedicaidAL
051506404OtherALMANCUSO BCBS

Other names 1

  • Heritage Family Medicine Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544140800000",
    "number": "1114141744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 617",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357580617",
            "telephone_number": "256-990-8446",
            "fax_number": "256-461-0393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12205 COUNTY LINE RD",
            "address_2": "SUITE B",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357587719",
            "telephone_number": "256-990-8446",
            "fax_number": "256-461-0393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAWN B MANCUSO, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2018-12-07",
        "status": "A",
        "authorized_official_last_name": "MANCUSO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "256-990-8446",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "00015990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529910550",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANCUSO BCBS",
            "identifier": "051506404",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.