Individual provider Active NPI

Laurie Danca Manzo, RD

  • Registered Dietitian
  • Boston, MA
National Provider Identifier
1396145918
Registry record updated Feb 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
2411 Issued in MA
Practice address
55 Fruit St
Yawkey Suite 6D
Boston, MA 02114-2621
Phone
(617) 726-2728
NPI assigned
Sep 2, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 2411 MA Primary

Addresses

Primary practice location

55 Fruit St
Yawkey Suite 6D
Boston, MA 02114-2621

Mailing address

55 Fruit St
Yawkey Suite 6D
Boston, MA 02114-2621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260611001472 MA Practitioner - Registered Dietitian Or Nutrition Professional 2062984958 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2026
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

399 Revolution Dr
Suite 458
Somerville, MA 02145-1488

Mass General Brigham Provider Enrollment
399 Revolution Drive Suite 458
Somerville, MA 02145-1572

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1409616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424908800000",
    "number": "1396145918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "YAWKEY SUITE 6D",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "YAWKEY SUITE 6D",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-2728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZO",
        "first_name": "LAURIE",
        "middle_name": "DANCA",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-02",
        "last_updated": "2015-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "2411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.