Jade N. Manczuk, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2012024502 Issued in MO

Practice address

3231 S. National
Suite 430
Springfield, MO 65807

Phone

(417) 888-5660

Fax

(417) 888-6793

NPI assigned

Sep 4, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: jade.manczuk.p1@direct.jordanvalley.nextgenshare.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.

• Mercy Hospital Springfield

  • Medicare Defined Swing Bed Hospital Unit
  • Springfield, MO
  • NPI 1053907113
  NPD (past)

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

{
    "created_epoch": "1346716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346716800000",
    "number": "1124377395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 504274",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631504274",
            "telephone_number": "417-820-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 S. NATIONAL",
            "address_2": "SUITE 430",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65807",
            "telephone_number": "417-888-5660",
            "fax_number": "417-888-6793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCZUK",
        "first_name": "JADE",
        "middle_name": "N.",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-04",
        "last_updated": "2012-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2012024502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "440552485",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John J. Maloney, PH.D.
• Benjamin Malonzo, AA
• Jennifer A Malossi, M.D.
• Managed Healthcare, LLC
• Shaveta Manchanda, MD
• Murali Mandava
• Donald H. Mangum, MD
• Hersh S Maniar, MD
• Ravinder Mankoo, M.D.
• Heather Manley, PLPC

• Registered Dietitian in Springfield, MO
• Providers in Springfield, MO by specialty
• Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; 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.