Martin M Mancuso MD PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

14017 Issued in NE

Legal business name

MARTIN M MANCUSO MD PC

Practice address

11704 W Center Rd Ste 210
Omaha, NE 68144-4327

Phone

(402) 334-3377

Fax

(402) 691-9922

NPI assigned

Sep 11, 2007

Organization subpart

No

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

Authorized official

Name

Mary Derouchey

Title

Practice Manager

Phone

(402) 330-0444

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218067200000",
    "number": "1326233545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11704 W CENTER RD STE 210",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681444327",
            "telephone_number": "402-334-3377",
            "fax_number": "402-691-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11704 W CENTER RD STE 210",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681444327",
            "telephone_number": "402-334-3377",
            "fax_number": "402-691-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN M MANCUSO MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2008-08-07",
        "status": "A",
        "authorized_official_last_name": "DEROUCHEY",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "402-330-0444"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "14017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0903674",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS RR MEDICARE",
            "identifier": "828013494",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anita Marti
• Lindsay Victoria Martian, R.D., L.M.N.T
• Linda Martig
• Martin a Stoltenberg Aprn-BC LLC
• Angela Marie Martin Jones
• Adrian Martin, M.S., LMFT, LIMHP
• Alicia D Martin
• Andrea Martin
• Angela Martin
• Ayonna K Martin

• All providers in Omaha, NE
• Internal Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.

Verify at the official NPI Registry.