Individual provider Active NPI

Max Mangano

  • Surgical Physician Assistant
  • Georgetown, MA
National Provider Identifier
1487274668
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
14 Tenney St
Georgetown, MA 01833-1710
Phone
(978) 852-5587
NPI assigned
Apr 17, 2020
Last updated
May 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X NU Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

14 Tenney St
Georgetown, MA 01833-1710

Mailing address

14 Tenney St
Georgetown, MA 01833-1710

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210504002672 MA Practitioner - Physician Assistant 5193134146 Reassigns benefits to 1 organization
I20221006000193 NH Practitioner - Physician Assistant 5193134146

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Tufts University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4 Centennial Dr
Suite 204
Peabody, MA 01960-7930
Phone (978) 977-0351

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mass General Brigham Medical Group Northern Massachusetts Inc CurrentSince Nov 21, 2025 Accepting new patients
LGH Professional Services LLC Past Accepting new patients

Locations

1 Hutchinson Dr
Danvers, MA 01923
Phone (978) 739-6950

4 Centennial Dr
Ste 204
Peabody, MA 01960
Phone (978) 977-0351

Interoperability endpoints

  • Direct secure messaging: mmangano85007@tuftsmedicine.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1487274668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 TENNEY ST",
            "city": "GEORGETOWN",
            "state": "MA",
            "postal_code": "018331710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 TENNEY ST",
            "city": "GEORGETOWN",
            "state": "MA",
            "postal_code": "018331710",
            "telephone_number": "978-852-5587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGANO",
        "first_name": "MAX",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-17",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, MA

Sources for this page

Verify at the official NPI Registry.