Individual provider Active NPI

Anthony S Mencucci, PT

  • Orthopedic Physical Therapist
  • Fairport, NY
National Provider Identifier
1659446441
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
0149671 Issued in NY
Practice address
790 Ayrault Rd
Fairport, NY 14450
Phone
(585) 425-1018
Fax
(585) 425-8955
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 0149671 NY Primary

Addresses

Primary practice location

790 Ayrault Rd
Fairport, NY 14450

Mailing address

417 Macedon Center Rd
Macedon, NY 14502
Phone (315) 986-7544

Other identifiers 3

IdentifierTypeStateIssuer
103116FTOtherNYPREFERRED CARE
P010014967OtherNYBLUE CHOICE
7344272OtherNYAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041006000636 NY Practitioner - Physical Therapist in Private Practice 7315906369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Star Physical Therapy PLLCGroup PAC ID 0648238832, 5 clinicians

Practice addresses (Care Compare)

790 Ayrault Rd
Fairport, NY 14450-8981

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
014967NYMDMental Health Counselor
0149671NYMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Star Physical Therapy PLLC Orthopedic CurrentSince Jan 1, 2005 Accepting new patients

Locations

790 Ayrault Rd
Ste 2
Fairport, NY 14450
Phone (585) 425-1018

790 Ayrault Rd
Fairport, NY 14450
Phone (585) 425-1018

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424736000000",
    "number": "1659446441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 MACEDON CENTER RD",
            "city": "MACEDON",
            "state": "NY",
            "postal_code": "14502",
            "telephone_number": "315-986-7544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 AYRAULT RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "14450",
            "telephone_number": "585-425-1018",
            "fax_number": "585-425-8955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENCUCCI",
        "first_name": "ANTHONY",
        "middle_name": "S",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2015-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NY",
            "license": "0149671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "103116FT",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "P010014967",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7344272",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.