Mayanka Tickoo, M.D., M.S.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

265375 Issued in MA

Practice address

300 Cedar St FL 4
New Haven, CT 06519

Phone

(203) 737-1240

NPI assigned

Jul 3, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

Pulmonary Disease

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pratt Medical Group IncGroup PAC ID 3375515661, 282 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lowell General Hospital Hospital, Lowell, MA, CCN 220063
• Tufts Medical Center Hospital, Boston, MA, CCN 220116
• Melrosewakefield Healthcare Hospital, Melrose, MA, CCN 220070
• South Shore Hospital Hospital, South Weymouth, MA, CCN 220100

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/d04f75c7-2a62-4686-b520-7bf0635f38f0/

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.

• Pratt Medical Group, Inc

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1275570319

  Pulmonary Disease

  Medicare reassignment Care Compare group NPD
• LGH Medical Group, Inc.

  • Hospitalist Physician
  • Lowell, MA
  • NPI 1174698385
  Medicare reassignment NPD
• Pratt Medical Group, Inc

  • Pulmonary Disease Physician
  • Boston, MA
  • NPI 1508187642
  NPD
• Pratt Medical Group, Inc

  • Cardiovascular Disease Physician
  • Boston, MA
  • NPI 1841510633

  Critical Care Medicine

  NPD
• LGH Professional Services LLC

  • Internal Medicine Physician
  • Lowell, MA
  • NPI 1417485541
  NPD (past)
• The Lowell General Hospital

  • General Acute Care Hospital
  • Lowell, MA
  • NPI 1407804669
  NPD (past)
• Tufts Medical Center, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1730132515
  NPD (past)

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

• Melrosewakefield Healthcare, Inc.

  • General Acute Care Hospital
  • Medford, MA
  • NPI 1841290467
  Care Compare affiliation
• South Shore Hospital Inc.

  • General Acute Care Hospital
  • South Weymouth, MA
  • NPI 1134227606
  Care Compare affiliation
• The Lowell General Hospital

  • General Acute Care Hospital
  • Lowell, MA
  • NPI 1407804669
  Care Compare affiliation
• Tufts Medical Center, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1730132515
  Care Compare affiliation

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

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526083200000",
    "number": "1669736765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "203-737-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CEDAR ST FL 4",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06519",
            "telephone_number": "203-737-1240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Washington St",
            "address_2": "Tufts Medical Center, Pulmonary Dept",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021111552",
            "country_code": "US",
            "telephone_number": "617-636-6366",
            "fax_number": "617-636-6361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TICKOO",
        "first_name": "MAYANKA",
        "name_prefix": "Dr.",
        "credential": "M.D., M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-03",
        "last_updated": "2018-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CT",
            "license": "60511",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CT",
            "license": "60511",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MA",
            "license": "265375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shreeya Thussu
• Tamires Tiburtino
• Siena Tice
• Douglas Edwin Tichy, PA-C
• Eileen Mary Tichy, PAC RD
• Sunil Kumar Tickoo, RPH
• Roger Tieu
• Lauren Tiffen, DDS, CPH
• Robert E Tigelaar, MD
• Mae K Tighe, M.D.

• Pulmonary Disease Physician in New Haven, CT
• Providers in New Haven, CT by specialty
• Pulmonary Disease Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2018; 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.