Active NPI
Manuel R Castresana, MD
- Anesthesiology Physician
- Augusta, GA
National Provider Identifier
1104917053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 022729
- Practice address
- 1120 15TH St
Room 2144
Augusta, GA 30912-0004 - Phone
- (706) 721-3873
- Fax
- (706) 721-7763
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 022729 | GA | Primary |
Addresses
Primary practice location
1120 15TH St
Room 2144
Augusta, GA 30912-0004
Mailing address
PO Box 28068
Chattanooga, TN 37424-8068
Phone (877) 899-1033
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004994 | Other | GA | BCBS |
| 550789920 | Other | GA | TRICARE |
| 000235529I | Medicaid | GA | |
| 339269 | Other | GA | WELLCARE CMO |
| G22729 | Medicaid | SC | |
| P00077013 | Other | GA | RRMEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213833600000",
"number": "1104917053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 28068",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374248068",
"telephone_number": "877-899-1033",
"fax_number": "423-892-5838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 15TH ST",
"address_2": "ROOM 2144",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120004",
"telephone_number": "706-721-3873",
"fax_number": "706-721-7763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASTRESANA",
"first_name": "MANUEL",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2008-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "GA",
"license": "022729",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "004994",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "550789920",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000235529I",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE CMO",
"identifier": "339269",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "G22729",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RRMEDICARE",
"identifier": "P00077013",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.