Mary A Mandziara, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

4704131950 Issued in MI

Practice address

19229 Mack Ave
Suite 34
Grosse Pointe Woods, MI 48236-2858

Phone

(313) 647-3245

Fax

(313) 647-3244

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Mary A Marchese Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmandziara1140017@direct.hfhs.org

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.

• Henry Ford Health St. John Hospital

  • Podiatrist
  • Harrison Township, MI
  • NPI 1043478910
  Medicare reassignment NPD
• Henry Ford Health St. John Hospital

  • Nurse Practitioner
  • Detroit, MI
  • NPI 1700831500
  Medicare reassignment NPD
• Henry Ford Health St. John Hospital

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1912965088
  NPD
• Henry Ford Health St. John Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414108800000",
    "number": "1669568341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19229 MACK AVE",
            "address_2": "SUITE 23",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362858",
            "telephone_number": "313-647-3245",
            "fax_number": "313-647-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19229 MACK AVE",
            "address_2": "SUITE 34",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362858",
            "telephone_number": "313-647-3245",
            "fax_number": "313-647-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDZIARA",
        "first_name": "MARY",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2014-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704131950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4327582",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PIN",
            "identifier": "0866737",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN LICENSE",
            "identifier": "4704131950",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MARCHESE",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• M.I.C.H., Inc.
• Ryan Mach
• Kendra K Malcolm
• Andrew Manardo, MS, CCC-SLP
• Toni Marie Mancini, PA-C
• Manor Pharmacy & Surgical Supply
• Lisa Allyn Manz Dulac, MD
• Marivic D. Massand MD,PLLC
• Danielle Marie Marken
• Pennie Marie Marko, CRNA

• Acute Care Nurse Practitioner in Grosse Pointe Woods, MI
• Providers in Grosse Pointe Woods, MI by specialty
• Acute Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.