Individual provider Active NPI

Elizabeth Manocchio, PA-C

  • Physician Assistant
  • Boston, MA
National Provider Identifier
1790248540
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA7029 Issued in MA
Practice address
830 Harrison Avenue, FL 3
Moakley Building
Boston, MA 02118
Phone
(617) 638-5600
Fax
(617) 638-7228
NPI assigned
Apr 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA7029 MA Primary

Addresses

Primary practice location

830 Harrison Avenue, FL 3
Moakley Building
Boston, MA 02118

Mailing address

801 Albany Street
FL Ground
Boston, MA 02119

Other practice location 1

1150 Douglas Pike
Smithfield, RI 02917-1291
Phone (401) 232-6230

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191120003150 MA Practitioner - Physician Assistant 5294167706 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA7029MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Medical Center Corporation Current Accepting new patients
Boston University General Surgical Associates, Inc.-QMC CurrentSince Jul 18, 2022 Accepting new patients

Locations

732 Harrison Ave
Fl 5
Boston, MA 02118
Phone (617) 414-6840

Interoperability endpoints

  • Direct secure messaging: emanocchio174829@direct.bmc.masshiway.net

Organizations & group practices 4

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": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1790248540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 ALBANY STREET",
            "address_2": "FL GROUND",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 HARRISON AVENUE, FL 3",
            "address_2": "MOAKLEY BUILDING",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118",
            "telephone_number": "617-638-5600",
            "fax_number": "617-638-7228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1150 Douglas Pike",
            "address_purpose": "LOCATION",
            "city": "Smithfield",
            "state": "RI",
            "postal_code": "029171291",
            "country_code": "US",
            "telephone_number": "401-232-6230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANOCCHIO",
        "first_name": "ELIZABETH",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-09",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA7029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.