NPIMap

Individual provider Active NPI

Destiny M Miller-Mancuso, M.D.

  • Family Medicine Physician
  • Le Mars, IA
National Provider Identifier
1306366729
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R-11054 Issued in IA
Practice address
714 Lincoln St. NE
Le Mars, IA 51031-3314
Phone
(712) 546-3492
Fax
(712) 546-3352
NPI assigned
Jun 27, 2017
Last updated
Aug 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R-11054 IA Primary

Addresses

Primary practice location

714 Lincoln St. NE
Le Mars, IA 51031-3314

Mailing address

714 Lincoln St. NE
Le Mars, IA 51031-3314
Phone (712) 546-3492

Other names 1

  • Destiny M Miller Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200717001077 IA Practitioner - Family Practice 7911263421 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Floyd Valley HealthcareGroup PAC ID 2769385475, shared by 5 NPIs, 35 clinicians

Practice addresses (Care Compare)

714 Lincoln St NE
Le Mars, IA 51031-3314
Phone (712) 546-3338

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates P.C. Family Medicine Current Accepting new patients
Floyd Valley Healthcare Current Accepting new patients
Floyd Valley Healthcare Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Floyd Valley Healthcare Current Accepting new patients
Floyd Valley Healthcare CurrentSince Sep 1, 2020 Accepting new patients

Locations

714 Lincoln St NE
Le Mars, IA 51031
Phone (712) 546-3338

Interoperability endpoints

  • Direct secure messaging: destiny.millermancuso@avera.sdhealthlink.net

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1306366729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 LINCOLN ST. NE",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510313314",
            "telephone_number": "712-546-3492",
            "fax_number": "712-546-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 LINCOLN ST. NE",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510313314",
            "telephone_number": "712-546-3492",
            "fax_number": "712-546-3352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER-MANCUSO",
        "first_name": "DESTINY",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R-11054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESTINY",
            "last_name": "MILLER",
            "middle_name": "M",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Le Mars, IA

Sources for this page

Verify at the official NPI Registry.