Manivanh A Prudhomme, MSN, FNP-BC, AGACNP-

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

904068 Issued in MS

Practice address

2011 Highway 61 N
Vicksburg, MS 39183-3918

Phone

(014) 562-2776

Fax

(601) 456-2622

NPI assigned

Aug 12, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Quad Intermed Company LLCGroup PAC ID 6709245954, 42 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Flowood, MS, CCN 257126
• Merit Health River Region Hospital, Vicksburg, MS, CCN 250031

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mprudhomme5164199@direct.casso.us.com

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.

• Quad Intermed Company LLC

  • Clinic/Center
  • Laurel, MS
  • NPI 1952099913
  Medicare reassignment Care Compare group NPD
• Quad Intermed Company LLC

  • Clinic/Center
  • Yazoo City, MS
  • NPI 1093403065
  NPD
• Quad Intermed Company LLC

  • Clinic/Center
  • Pearl, MS
  • NPI 1205619483
  NPD
• Riverbend Eyecare, P.a.

  • Optometrist
  • Vicksburg, MS
  • NPI 1811957624
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Home Health Care Affiliates of Central Mississippi, LLC

  • Home Health Agency
  • Flowood, MS
  • NPI 1417935578
  Care Compare affiliation
• Vicksburg Healthcare LLC

  • General Acute Care Hospital
  • Vicksburg, MS
  • NPI 1215981303
  Care Compare affiliation

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1144831140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "39183",
            "telephone_number": "601-456-2277",
            "fax_number": "601-456-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391833918",
            "telephone_number": "014-562-2776",
            "fax_number": "601-456-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDHOMME",
        "first_name": "MANIVANH",
        "middle_name": "A",
        "credential": "MSN, FNP-BC, AGACNP-",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-12",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Patricia Primeaux, MSN, APRN, AGACNP-BC
• Maurice L Prince Jr., MD
• Private Home Care, Inc.
• Professional Optical of Mississippi Inc
• Promise Hospital of Vicksburg Inc
• Cheryl Puckett
• Pulmonary Diagnostic Services LLC
• Karan Puri, MD
• Purple Heart Home Care LLC
• Morgan Purvis

• Family Nurse Practitioner in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.