NPIMap

Individual provider Active NPI

Marc Damian Manganiello, M.D.

  • Urology Physician
  • Beverly, MA
National Provider Identifier
1801059837
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
243611 Issued in MA
Practice address
75 Herrick St Ste 219
Beverly, MA 01915-5900
Phone
(978) 927-0714
Fax
(978) 927-9135
NPI assigned
Jul 9, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 243611 MA Primary

Addresses

Primary practice location

75 Herrick St Ste 219
Beverly, MA 01915-5900

Mailing address

75 Herrick St Ste 219
Beverly, MA 01915-5900
Phone (978) 927-0714

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140910001820 MA Practitioner - Urology 3577782341 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Loyola University of Chicago, Stritch School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The General Hospital CorporationGroup PAC ID 6507803806, 1,275 clinicians

Practice addresses (Care Compare)

102 Endicott St
MGH North Shore Medical
Danvers, MA 01923-3623
Phone (978) 882-6100

55 Fruit St
Boston, MA 02114-2621
Phone (617) 726-2000

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
243611MAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Jul 1, 2016 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Jul 1, 2016 Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince Dec 1, 2021 Accepting new patients
General Hospital Corp Current Accepting new patients
The General Hospital Corporation CurrentSince Dec 1, 2021 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Urology CurrentSince Jul 1, 2016 Accepting new patients
Beth Israel Lahey Health Primary Care, Inc. CurrentSince Aug 27, 2018 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Jul 1, 2016 Accepting new patients
Beth Israel Lahey Health Specialty Care, Inc. CurrentSince Aug 16, 2021 Accepting new patients
Beth Israel Lahey Health Specialty Care, Inc. Urology CurrentSince Aug 16, 2021 Accepting new patients
Beth Israel Lahey Health Primary Care Inc CurrentSince Aug 27, 2018 Accepting new patients

Locations

75 Herrick St
Ste 219
Beverly, MA 01915
Phone (978) 927-0714

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

480 Maple St
Danvers, MA 01923
Phone (978) 304-8380

57 Bedford St
Ste 130
Lexington, MA 02420
Phone (781) 484-7500

15 Railroad Ave
South Hamilton, MA 01982
Phone (978) 468-7381

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10729/brand/1/csg/1/fhir/r4
  • Direct secure messaging: manganiello.marc.mgh@direct.partners.masshiway.net

Organizations & group practices 11

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1801059837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 HERRICK ST STE 219",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019155900",
            "telephone_number": "978-927-0714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 HERRICK ST STE 219",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019155900",
            "telephone_number": "978-927-0714",
            "fax_number": "978-927-9135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGANIELLO",
        "first_name": "MARC",
        "middle_name": "DAMIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MA",
            "license": "243611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

Verify at the official NPI Registry.