Izzuddin Ali Mansur, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD30604 Issued in TN

Practice address

49 Cleveland St
Suite 220
Crossville, TN 38555-2855

Phone

(931) 707-8050

Fax

(931) 707-8048

NPI assigned

Apr 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Urology

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cumberland Medical Center Hospital, Crossville, TN, CCN 440009

Merit-based Incentive Payment System (MIPS)

Final score

91.25 of 100Reported as individual

Quality

84.1

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Covenant Medical Group, Inc.

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1457302010

  Urology

  Medicare reassignment Care Compare group NPD
• Covenant Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Knoxville, TN
  • NPI 1871269415
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cumberland Medical Center, Inc.

  • General Acute Care Hospital
  • Crossville, TN
  • NPI 1871596403
  Care Compare affiliation

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1508828344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 CLEVELAND ST",
            "address_2": "SUITE 220",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385552855",
            "telephone_number": "931-707-8050",
            "fax_number": "931-707-8048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 CLEVELAND ST",
            "address_2": "SUITE 220",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385552855",
            "telephone_number": "931-707-8050",
            "fax_number": "931-707-8048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSUR",
        "first_name": "IZZUDDIN",
        "middle_name": "ALI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TN",
            "license": "MD30604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q063406",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mansur.izzuddin@covenathealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "49 Cleveland St",
            "address_2": "Suite 220",
            "city": "Crossville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "385552855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Debra K Main, MS, LPC
• Majdoc71, PLLC
• Raghu Mallapura Purushothama Reddy, M.D
• Luisa T Manestar, MD
• William M Manning, CRNA
• Linnea Desiree Marchand, FNP
• Mark Neal Hendrixson MD
• Cassie Martin, LPN
• Megann Maynard, PHARMD
• Roy McClanahan

• Urology Physician in Crossville, TN
• Providers in Crossville, TN by specialty
• Urology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.

Verify at the official NPI Registry.