Provider Demographics
NPI:1427012574
Name:MANCUSO, GERALD M (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:M
Last Name:MANCUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CARONDELET DR STE 201B
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4673
Mailing Address - Country:US
Mailing Address - Phone:913-956-2250
Mailing Address - Fax:913-956-2251
Practice Address - Street 1:1000 CARONDELET DR STE 201B
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114
Practice Address - Country:US
Practice Address - Phone:913-956-2250
Practice Address - Fax:913-956-2251
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1K08207RC0000X, 207RI0011X, 207R00000X
KS04-22976207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE39881Medicare UPIN
MO1427012574Medicaid
MOE39881Medicare UPIN
MOB751516Medicare ID - Type Unspecified
MOMA2231018Medicare PIN
MO15628021OtherBCBS-KC
MO110095791OtherRAILROAD MEDICARE