Active NPI
John R Manzella Jr., DO
- Internal Medicine Physician
- Jim Thorpe, PA
National Provider Identifier
1225012891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- OS010263L
- Practice address
- 1353 State Route 903
Jim Thorpe, PA 18229-2734 - Phone
- (570) 325-8393
- Fax
- (570) 325-8029
- NPI assigned
- Dec 6, 2005
- Last updated
- Jul 8, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OS010263L | PA | Primary |
| Pediatrics Physician | 208000000X | OS010263L | PA |
Addresses
Primary practice location
1353 State Route 903
Jim Thorpe, PA 18229-2734
Mailing address
1353 State Route 903
Jim Thorpe, PA 18229-2734
Phone (570) 325-8393
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0314295000 | Other | PERSONAL BLUE SHIELD | |
| 03197301 | Other | CAPITAL BLUE CROSS | |
| 010054200 | Other | BLACK LUNG | |
| 5389099 | Other | AETNA | |
| 001780247 | Medicaid | PA | |
| 176513 | Other | PA | BLUE SHIELD |
| 2968846 | Other | GHI | |
| 20031252 | Other | AMERIHEALTH MERCY | |
| P00600418 | Other | PA | PALMETTO |
| 1753980 | Other | FEDERAL BLUE SHIELD | |
| 176513 | Other | AMERIHEALTH ADMIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS010263L | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Compassionate Care Hospice of Northwestern Pennsylvania, LLC | Past | Accepting new patients | |
| Community Resource Nurse Practitioners, LLC | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EDCGCD/Endpoint/EDCGCD
Organizations & group practices 2
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.
-
dba Community Resource Nurse Practitioners
- Family Nurse Practitioner
- Stroudsburg, PA
- NPI 1386888774
-
- Community Based Hospice Care Agency
- Olyphant, PA
- NPI 1386647915
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215475200000",
"number": "1225012891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1353 STATE ROUTE 903",
"city": "JIM THORPE",
"state": "PA",
"postal_code": "182292734",
"telephone_number": "570-325-8393",
"fax_number": "570-325-8029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1353 STATE ROUTE 903",
"city": "JIM THORPE",
"state": "PA",
"postal_code": "182292734",
"telephone_number": "570-325-8393",
"fax_number": "570-325-8029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANZELLA",
"first_name": "JOHN",
"middle_name": "R",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-06",
"last_updated": "2008-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "OS010263L",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "OS010263L",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONAL BLUE SHIELD",
"identifier": "0314295000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "03197301",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLACK LUNG",
"identifier": "010054200",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5389099",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001780247",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "176513",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "2968846",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH MERCY",
"identifier": "20031252",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO",
"identifier": "P00600418",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLUE SHIELD",
"identifier": "1753980",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH ADMIN",
"identifier": "176513",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Jim Thorpe, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.