Stephanie Anne Manceor, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4137 Issued in TN

Practice address

244 Saranac Dr
Sunset, SC 29685-1619

Phone

(713) 419-6547

NPI assigned

Apr 21, 2020

Last updated

Apr 21, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Itrust Wellness GroupGroup PAC ID 0648532028, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Itrust Wellness Group

  • Psychiatry Physician
  • Greenville, SC
  • NPI 1629517222
  Medicare reassignment Care Compare group
• Itrust Cares LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Greenville, SC
  • NPI 1225751068
  NPD (past)

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1821618604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 SARANAC DR",
            "city": "SUNSET",
            "state": "SC",
            "postal_code": "296851619",
            "telephone_number": "713-419-6547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 SARANAC DR",
            "city": "SUNSET",
            "state": "SC",
            "postal_code": "296851619",
            "telephone_number": "713-419-6547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCEOR",
        "first_name": "STEPHANIE",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-21",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Ridge Physical Therapy, LLC (Blue Ridge Physical Therapy)
• Kenneth Clarke Kunze, MD

• Physician Assistant in Sunset, SC
• Providers in Sunset, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.