NPIMap

Organization Active NPI

Bruncuso Holdings Chapter Two LLC

  • Family Nurse Practitioner
  • Cave Creek, AZ
National Provider Identifier
1740050822
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
BRUNCUSO HOLDINGS CHAPTER TWO LLC
Practice address
4425 E Villa Cassandra Way
Cave Creek, AZ 85331-9564
Phone
(206) 755-6699
NPI assigned
Jan 8, 2024
Organization subpart
Yes
Parent organization
BRUNCUSO HOLDINGS CHAPTER TWO LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Traci MancusoNPI 1619069226
Title
Owner/Operator
Phone
(206) 755-6699

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

4425 E Villa Cassandra Way
Cave Creek, AZ 85331-9564

Mailing address

4425 E Villa Cassandra Way
Cave Creek, AZ 85331-9564

Other names 1

  • Transitional Care Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240307002879 NV Part B Supplier - Clinic/Group Practice 8426491093 Receives reassigned benefits from 2 practitioners
Practice locations: Carson City, NV

National Provider Directory

National Provider Directory
Part of
Bruncuso Holdings Chapter Two LLC

Locations

123 W Nye Ln
Ste 129
Carson City, NV 89706
Phone (480) 847-2273

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1740050822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 E VILLA CASSANDRA WAY",
            "city": "CAVE CREEK",
            "state": "AZ",
            "postal_code": "853319564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 E VILLA CASSANDRA WAY",
            "city": "CAVE CREEK",
            "state": "AZ",
            "postal_code": "853319564",
            "telephone_number": "206-755-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUNCUSO HOLDINGS CHAPTER TWO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRUNCUSO HOLDINGS CHAPTER TWO LLC",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "MANCUSO",
        "authorized_official_first_name": "TRACI",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "206-755-6699"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Transitional Care Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cave Creek, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.