Kenneth Maniscalco Jr., MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

57631 Issued in TN

Practice address

1501 Kings Hwy
Em
Shreveport, LA 71103

Phone

(318) 675-6632

NPI assigned

Apr 8, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Emergency Medicine

Education

Louisiana State University School of Medicine in Shreveport, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tennessee River Physicians, PLLCGroup PAC ID 8022387349, 65 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Erlanger Medical Center Hospital, Chattanooga, TN, CCN 440104

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Tennessee River Physicians, PLLC

  • Emergency Medicine Physician
  • Chattanooga, TN
  • NPI 1396282463
  Medicare reassignment Care Compare group NPD
• Tennessee River Physicians, PLLC

  • Emergency Medicine Physician
  • Dunlap, TN
  • NPI 1699212761
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Erlanger Health

  • General Acute Care Hospital
  • Chattanooga, TN
  • NPI 1861194086
  Care Compare affiliation

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

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1275929036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "EM",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-6632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "EM",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71103",
            "telephone_number": "318-675-6632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANISCALCO",
        "first_name": "KENNETH",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-08",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "57631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latoyta Mandosia
• Kellie Mandygo
• Matthew Manfredo, MD
• Payton Mangham
• Elizabeth Mangum, NP
• Gauri Mankekar, MD,PHD
• Adrian Manning
• Candice Manning
• Jordyn Manning, MSN, APRN, PMHNP
• Lasonia Sowers Manning

• Emergency Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Emergency Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.