Active NPI
Manal S Soliman, M.D.
- Family Medicine Physician
- Green Bay, WI
National Provider Identifier
1104867084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 70858
- Practice address
- 1727 Shawano Ave
Green Bay, WI 54303-3268 - Phone
- (920) 496-4700
- NPI assigned
- Jun 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 225730 | NY | |
| Family Medicine Physician | 207Q00000X | 70858 | WI | Primary |
Addresses
Primary practice location
1727 Shawano Ave
Green Bay, WI 54303-3268
Mailing address
PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7537369 | Other | NY | AETNA |
| 02369262 | Medicaid | NY | |
| 48V291 | Other | NY | EMPIRE BC.BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 225730 | NY | MD | Licensed Practical Nurse |
| 70858 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sun River Health Inc | Current | Accepting new patients | |
| West Yavapai Guidance Clinic | Past | Accepting new patients | |
| West Yavapai Guidance Clinic, Inc | Past | Accepting new patients |
Locations
3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006
Organizations & group practices 3
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.
-
- Federally Qualified Health Center (FQHC)
- Amenia, NY
- NPI 1568526838
-
- Psychiatric Hospital
- Prescott, AZ
- NPI 1023836533
-
- Psychiatric Hospital
- Prescott, AZ
- NPI 1952550071
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660003200000",
"number": "1104867084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19070",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543079070",
"telephone_number": "920-496-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1727 SHAWANO AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543033268",
"telephone_number": "920-496-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOLIMAN",
"first_name": "MANAL",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-09",
"last_updated": "2022-08-09",
"certification_date": "2022-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "225730",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "70858",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7537369",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02369262",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BC.BS",
"identifier": "48V291",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.