Individual provider Active NPI

Jessica Mancuso, FNP

  • Nurse Practitioner
  • Williamsville, NY
National Provider Identifier
1437679834
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
341884 Issued in NY
Practice address
297 Spindrift Dr
Williamsville, NY 14221-7894
Phone
(716) 831-2600
NPI assigned
Jun 27, 2017
Last updated
Nov 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 341884 NY Primary

Addresses

Primary practice location

297 Spindrift Dr
Williamsville, NY 14221-7894

Mailing address

297 Spindrift Dr
Williamsville, NY 14221-7894
Phone (716) 831-2600

Other identifiers 1

IdentifierTypeStateIssuer
04831605MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170817000780 NY Practitioner - Nurse Practitioner 8224300876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western New York Dermatology PLLCGroup PAC ID 6103141619, 15 clinicians

Practice addresses (Care Compare)

297 Spindrift Dr
Suite 100
Williamsville, NY 14221-7894
Phone (716) 831-2600

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
96.67
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Western New York Dermatology, PLLC CurrentSince Nov 1, 2021 Accepting new patients

Locations

297 Spindrift Dr
Williamsville, NY 14221
Phone (716) 635-0688

297 Spindrift Dr
Ste 100
Williamsville, NY 14221
Phone (716) 631-8863

Organizations & group practices 1

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.

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": "1637539200000",
    "number": "1437679834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 SPINDRIFT DR",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142217894",
            "telephone_number": "716-831-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 SPINDRIFT DR",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142217894",
            "telephone_number": "716-831-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCUSO",
        "first_name": "JESSICA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "341884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04831605",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.