Physician Compare National (NPI:1013069897)

HEALTHCARE PROVIDER: NICHOLAS THOMAS MANSUETTA D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1013069897
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4284734583
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120402000383
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MANSUETTA
	Individual professional last name
Provider First Name	NICHOLAS
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NOVA SOUTHEASTERN COLLEGE OF OSTEO MEDICINE
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HAND SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HAND SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	3500 CENTRAL AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE A
	Group Practice or individual's line 2 address
City	KEARNEY
	Group Practice or individual's city
State	NE
	Group Practice or individual's state
Zip Code	688472963
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	280009
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHI HEALTH GOOD SAMARITAN
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	280138
	Medicare CCN of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y