NPIMap

Individual provider Active NPI

Brandon Robert Mancini, M.D.

  • Radiation Oncology Physician
  • Grand Rapids, MI
National Provider Identifier
1366731838
Registry record updated Apr 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
4301110708 Issued in MI
Practice address
109 Michigan St NW Ste 200
Grand Rapids, MI 49503-2302
Phone
(616) 330-2522
NPI assigned
Apr 5, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 4301110708 MI Primary

Addresses

Primary practice location

109 Michigan St NW Ste 200
Grand Rapids, MI 49503-2302

Mailing address

109 Michigan St NW Ste 200
Grand Rapids, MI 49503-2302
Phone (616) 330-2522

Other practice location 1

1500 E Medical Center Drive
B2 floor University Hospital Rm C490
Ann Arbor, MI 48109-5010
Phone (734) 936-4300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20160826000287 MI Practitioner - Radiation Oncology 1456662675 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bamf Health I PCGroup PAC ID 7911394556, 5 clinicians

Practice addresses (Care Compare)

109 Michigan St NW
Suite 200
Grand Rapids, MI 49503-2302
Phone (616) 330-2522

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301110708MIMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary'S Medical Group CurrentSince Sep 1, 2016 Accepting new patients
West Michigan Cancer Center Radiation Oncology Current Accepting new patients
West Michigan Cancer Center Radiation Oncology CurrentSince Dec 10, 2018 Accepting new patients
Bamf Health I PC Radiation Oncology CurrentSince Jun 1, 2022 Accepting new patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Sep 1, 2016 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

109 Michigan St NW
Ste 200
Grand Rapids, MI 49503
Phone (616) 330-2522

200 N Park St
Kalamazoo, MI 49007
Phone (269) 373-7453

Interoperability endpoints

  • Direct secure messaging: brandon.mancini.1@27453.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1366731838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 MICHIGAN ST NW STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032302",
            "telephone_number": "616-330-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 MICHIGAN ST NW STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032302",
            "telephone_number": "616-330-2522"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 E Medical Center Drive",
            "address_2": "B2 floor University Hospital Rm C490",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481095010",
            "country_code": "US",
            "telephone_number": "734-936-4300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANCINI",
        "first_name": "BRANDON",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-05",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MI",
            "license": "4301110708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.