Kathryn Mary Mansueti

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601010730 Issued in MI

Practice address

1550 Riverside Ave Ste a
Jacksonville, FL 32204-4162

Phone

(904) 923-6647

Fax

(904) 355-7788

NPI assigned

Aug 10, 2021

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 FL

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Precision Dermatology and Skin Surgery PAGroup PAC ID 1153547989, 7 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: kathryn.mansueti.1@9889.direct.athenahealth.com
• Direct secure messaging: kathrynmansueti@precisiondermatologyandskinsurgery.emadirect.md

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.

• Precision Dermatology and Skin Surgery PA

  • Dermatology Physician
  • Jacksonville, FL
  • NPI 1336553619
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1841965175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 RIVERSIDE AVE STE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044162",
            "telephone_number": "904-923-6647",
            "fax_number": "904-355-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 RIVERSIDE AVE STE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044162",
            "telephone_number": "904-923-6647",
            "fax_number": "904-355-7788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1209 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320734158",
            "country_code": "US",
            "telephone_number": "904-923-6647",
            "fax_number": "904-355-7788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSUETI",
        "first_name": "KATHRYN",
        "middle_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-10",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Raymond Mansfield, PHARMACIST
• Kristin Manson
• Grace Marie Mansour, OTR/L
• Lauren Ann Mansour, MD
• Megan Marie Mansour, MD
• Kadir Mansur, MD
• Steven A Mantegari, DDS, MD
• Kalyan Mantha, MD
• Manther'S Place Counseling LLC
• Manthers Place Counseling

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.