Active NPI
Aretha Nanda Persaud-Mancusi, M.D.
- Family Medicine Physician
- Melville, NY
National Provider Identifier
1497861843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 228552
- Practice address
- 150 Broadhollow Rd Ste 311
Melville, NY 11747-4901 - Phone
- (631) 470-7915
- Fax
- (631) 470-7922
- NPI assigned
- Aug 21, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 228552 | NY | Primary |
Addresses
Primary practice location
150 Broadhollow Rd Ste 311
Melville, NY 11747-4901
Mailing address
1010 Northern Blvd Ste 328
Great Neck, NY 11021-5329
Phone (516) 233-2484
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5763A1 | Other | NY | BLUE CROSS AND BLUE SHIELD |
| P3715262 | Other | NY | OXFORD |
| PA8552 | Other | NY | ATLANTIS HEALTHCARE |
| 116432 | Other | NY | GHI |
| 1396247 | Other | NY | AETNA |
| 2387689 | Other | NY | UNITED HEALTHCARE |
| 349448P | Other | HIP |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
150 Broadhollow Rd
Suite 311
Melville, NY 11747-4901
Phone (631) 470-7915
Hospital & facility affiliations
- Peconic Bay Homehealth Services
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 228552 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anthony J Antonucci M D P C | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
Interoperability endpoints
- aretha.persaudmancusi@pmp150.eclinicaldirectplus.com
- https://fhir4.healow.com/fhir/r4/HBJGDD/Endpoint/HBJGDD
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.
-
- Adult Medicine Physician
- Melville, NY
- NPI 1942329107
-
- Internal Medicine Physician
- Huntington, NY
- NPI 1083751879
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Riverhead, NY
- NPI 1932155678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729641600000",
"number": "1497861843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 NORTHERN BLVD STE 328",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110215329",
"telephone_number": "516-233-2484",
"fax_number": "516-304-5850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 BROADHOLLOW RD STE 311",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117474901",
"telephone_number": "631-470-7915",
"fax_number": "631-470-7922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERSAUD-MANCUSI",
"first_name": "ARETHA",
"middle_name": "NANDA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-21",
"last_updated": "2024-10-23",
"certification_date": "2024-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "228552",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIELD",
"identifier": "5763A1",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P3715262",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATLANTIS HEALTHCARE",
"identifier": "PA8552",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "116432",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1396247",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2387689",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "349448P",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.