Active NPI
Theresa Manning, APRN
- Nurse Practitioner
- Somerville, MA
National Provider Identifier
1417079922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 192595
- Practice address
- 120 Beacon St Ste 202
House Call Program
Somerville, MA 02143-4398 - Phone
- (617) 868-6323
- NPI assigned
- Apr 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 192595 | MA | Primary |
Addresses
Primary practice location
120 Beacon St Ste 202
House Call Program
Somerville, MA 02143-4398
Mailing address
120 Beacon St Ste 202
House Call Program
Somerville, MA 02143-4398
Phone (617) 868-6323
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110074832A | Medicaid | MA | |
| NP1088 | Other | MA | BCBS MA PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 192595 | MA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328572800000",
"number": "1417079922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 BEACON ST STE 202",
"address_2": "HOUSE CALL PROGRAM",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021434398",
"telephone_number": "617-868-6323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 BEACON ST STE 202",
"address_2": "HOUSE CALL PROGRAM",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021434398",
"telephone_number": "617-868-6323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANNING",
"first_name": "THERESA",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-04",
"last_updated": "2012-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "192595",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110074832A",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA PROVIDER NUMBER",
"identifier": "NP1088",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Somerville, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.