Nicole Lisette Mancinelli, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

2195 Issued in OK

Practice address

2424 E. 21St Street
Suite 320
Tulsa, OK 74114

Phone

(918) 392-4547

Fax

(918) 392-4555

NPI assigned

Feb 1, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Oklahoma City, Inc Hospital, Oklahoma City, OK, CCN 370013

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment Care Compare group
• St. John Physicians, Inc.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1336194406
  Medicare reassignment NPD (past)
• Orthopedic & Trauma Service of Oklahoma, PC

  • Medical Specialty Clinic/Center
  • Tulsa, OK
  • NPI 1235316829
  Medicare reassignment
• St John Urgent Care Clinics Inc

  • Urgent Care Clinic/Center
  • Tulsa, OK
  • NPI 1003918830
  Medicare reassignment
• St. John Physicians, Inc

  • Rural Health Clinic/Center
  • Barnsdall, OK
  • NPI 1033176367
  NPD

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

• Mercy Hospital Oklahoma City, Inc

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1184721722
  Care Compare affiliation

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

{
    "created_epoch": "1359676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1619216272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2909 E 97TH CT",
            "address_2": "APT. 2212",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741377435",
            "telephone_number": "918-392-4547",
            "fax_number": "918-392-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 E. 21ST STREET",
            "address_2": "SUITE 320",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74114",
            "telephone_number": "918-392-4547",
            "fax_number": "918-392-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCINELLI",
        "first_name": "NICOLE",
        "middle_name": "LISETTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-01",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "2195",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "2195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200474170A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristal Rose Malveaux, LCSW
• Robert Benedict Mammana, M.D.
• Management Worldwide, LLC
• Dee Ann Manatowa, BSW
• James Manchester
• Donna Mancini
• Margaret Manders
• Carol P Mandlebaum, BS
• Joey M Manduano, D.O.
• Michael Lindsey Manes, M.S., L.P.C.

• Surgical Physician Assistant in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Surgical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.