Surjit S Maniktala, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

53518 Issued in MA

Practice address

30 Meadowbrook Rd
Brockton, MA 02301-7122

Phone

(508) 584-9520

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• High Point Treatment Center Inc.

  • Counselor
  • New Bedford, MA
  • NPI 1518996354
  Medicare reassignment NPD
• The Commonwealth of Massachusetts

  dba Tewksbury Hospital

  • Long Term Care Hospital
  • Tewksbury, MA
  • NPI 1871680496
  Medicare reassignment NPD
• Uhs of Fuller Inc

  dba Fuller Hospital

  • Psychiatric Hospital
  • S Attleboro, MA
  • NPI 1316917222

  Internal Medicine

  Medicare reassignment NPD
• The Commonwealth of Massachusetts

  dba Soldiers' Home in Holyoke

  • General Acute Care Hospital
  • Holyoke, MA
  • NPI 1427111574
  NPD
• High Point Treatment Center Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • New Bedford, MA
  • NPI 1932691524
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1801980594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MEADOWBROOK RD",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017122",
            "telephone_number": "508-584-9520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MEADOWBROOK RD",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017122",
            "telephone_number": "508-584-9520"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Washington St",
            "address_purpose": "LOCATION",
            "city": "Norwood",
            "state": "MA",
            "postal_code": "020623487",
            "country_code": "US",
            "telephone_number": "781-769-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Washington St",
            "address_purpose": "LOCATION",
            "city": "Norwood",
            "state": "MA",
            "postal_code": "020623487",
            "country_code": "US",
            "telephone_number": "781-769-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANIKTALA",
        "first_name": "SURJIT",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "53518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "764557",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110057924A",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "J13686",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "110211580",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH CA",
            "identifier": "698120",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theresa Marie Manegre, RD
• Lisa M Manera, M.D.
• Shannon Maney, PSY.D., ABPP
• Dominique Manigat-Estimphile
• Phernel Manigat
• Matthew David Mann, NP
• William Christopher Manners
• Kara Faye Manning, PHD
• Theresa Mae Manning
• Rana Mansour, M.D.

• Internal Medicine Physician in Brockton, MA
• Providers in Brockton, MA by specialty
• Internal Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.