Gerald L Mancebo, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

14580 Issued in TN

Practice address

501 20TH St Ste 404
Knoxville, TN 37916-1822

Phone

(865) 522-6964

Fax

(833) 908-2088

NPI assigned

Jun 15, 2006

Sex

Male

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 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gerald.mancebo.1@16930.direct.athenahealth.com

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.

• Summit Medical Group, PLLC

  • Internal Medicine Physician
  • Brentwood, TN
  • NPI 1659090298
  Medicare reassignment NPD
• Summit Medical Group, PLLC

  • Internal Medicine Physician
  • Powell, TN
  • NPI 1609955970
  NPD

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1700820131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 DICK LONAS RD UNIT 101",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091383",
            "telephone_number": "865-500-2143",
            "fax_number": "865-381-1509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 20TH ST STE 404",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161822",
            "telephone_number": "865-522-6964",
            "fax_number": "833-908-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCEBO",
        "first_name": "GERALD",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "14580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "1100098566",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3198177",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Malone, R.N.
• Maltman Medical Center LLC
• Stacey Maltman, FNP-BC
• Christopher R Malz
• Management Solutions LLC
• Gregory John Mancini, MD
• Matthew L Mancini, M.D.
• Ellen Elizabeth Maner
• Pamela M Maness, CRNA
• Selina Mang

• Internal Medicine Physician in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; 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.