Jack M Mancus, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

144030 Issued in NY

Practice address

37 Miles Wood Rd
Rhinebeck, NY 12572-1852

Phone

(845) 242-2630

Fax

(845) 876-2844

NPI assigned

Jan 29, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1164568911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 MILES WOOD RD",
            "city": "RHINEBECK",
            "state": "NY",
            "postal_code": "125721852",
            "telephone_number": "845-242-2630",
            "fax_number": "845-876-2844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 MILES WOOD RD",
            "city": "RHINEBECK",
            "state": "NY",
            "postal_code": "125721852",
            "telephone_number": "845-242-2630",
            "fax_number": "845-876-2844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCUS",
        "first_name": "JACK",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "144030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Sadie Lynch
• Russell Macek, RN
• Lori Macisaac, R PAC
• Michael Christopher Madigan, O.D.
• Susan Lynn Maher, R.PH.
• Anna Manente
• Tammy L Manicone, PTA
• Nathaniel Mapstone
• Daniel Mardit
• Cassandra Ann Martell, LMSW

• All providers in Rhinebeck, NY
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.