Individual provider Active NPI

Rana Mansour, M.D.

  • Internal Medicine Physician
  • Brockton, MA
National Provider Identifier
1114182961
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
251751 Issued in MA
Practice address
680 Centre St
Brockton, MA 02302-3308
Phone
(508) 941-7299
NPI assigned
Jul 22, 2008
Last updated
Jul 19, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125055497 IL
Internal Medicine Physician 207R00000X 251751 MA Primary

Addresses

Primary practice location

680 Centre St
Brockton, MA 02302-3308

Mailing address

680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7299

Other practice location 1

2160 S 1st Ave
Maywood, IL 60153-3328
Phone (708) 216-5332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, IL2 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

Enrollment IDStateProvider typePAC IDDetails
I20120820000726 MA Practitioner - HospitalistPractitioner - Internal Medicine 8325295728 Reassigns benefits to 2 organizations
I20230830001471 IL Practitioner - HospitalistPractitioner - Internal Medicine 8325295728 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125055497ILMDInternal Medicine Physician
251751MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. Internal Medicine CurrentSince Oct 24, 2014 Accepting new patients
Physicians of Cape Cod Hospital Internal Medicine CurrentSince Apr 19, 2024 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Jul 17, 2023 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Jul 17, 2023 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Oct 24, 2014 Accepting new patients
Cape Cod Hospital Inc Past Accepting new patients

Locations

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

27 Park St
Hyannis, MA 02601
Phone (508) 775-5011

101 Page St
New Bedford, MA 02740
Phone (508) 961-5425

Interoperability endpoints

  • Direct secure messaging: rmansour19958@direct.southcoast.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.

NPI Registry JSON

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1114182961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 CENTRE ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023308",
            "telephone_number": "508-941-7299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 CENTRE ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023308",
            "telephone_number": "508-941-7299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2160 S 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Maywood",
            "state": "IL",
            "postal_code": "601533328",
            "country_code": "US",
            "telephone_number": "708-216-5332",
            "fax_number": "708-216-5617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "RANA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-22",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125055497",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "251751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.