Gary W Manly, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

CRNA416 Issued in AR

Practice address

1801 W 40TH Ave
Ste 2B
Pine Bluff, AR 71603-6957

Phone

(870) 535-7457

Fax

(870) 535-2522

NPI assigned

Jun 16, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/howard-9d20da0d

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.

• Howard Memorial Hospital

  • Certified Registered Nurse Anesthetist
  • Nashville, AR
  • NPI 1609920370

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Howard Memorial Hospital

  • Clinical Neuropsychologist
  • Nashville, AR
  • NPI 1104282664
  NPD
• Jefferson Anesthesiology Associates

  • Anesthesiology Physician
  • Pine Bluff, AR
  • NPI 1023005550
  NPD (past)
• Stuttgart Regional Medical Center

  • General Acute Care Hospital
  • Stuttgart, AR
  • NPI 1306921747
  NPD (past)
• Stuttgart Regional Medical Center

  • Certified Registered Nurse Anesthetist
  • Stuttgart, AR
  • NPI 1316955891

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1023013000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1272",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716131272",
            "telephone_number": "870-535-7457",
            "fax_number": "870-535-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W 40TH AVE",
            "address_2": "STE 2B",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036957",
            "telephone_number": "870-535-7457",
            "fax_number": "870-535-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANLY",
        "first_name": "GARY",
        "middle_name": "W",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "CRNA416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125082701",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE/HUMANA",
            "identifier": "AR6003789",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "59625",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR/PGBA",
            "identifier": "430014160",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Magnifique, Inc. (Supreme Medical Supply)
• Sadeem Mahmood, M.D.
• John Makary, MD
• Mohammed Malik, M.D.
• Sharon D Mallett
• Charlene Mann, PTA
• Chantale Eva Manning, SLP
• Ebony Manning
• Mark Ramiro, M.D.,P.a.
• Sha'Keitha Marks, QBHP

• Certified Registered Nurse Anesthetist in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Certified Registered Nurse Anesthetist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.