Individual provider Active NPI

Givenchy Manzano, MD

  • Orthopaedic Surgery Physician
  • Charlotte, NC
National Provider Identifier
1194145813
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
2020-00306 Issued in NC
Practice address
1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204-2963
Phone
(704) 355-5982
NPI assigned
Apr 21, 2014
Last updated
Nov 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 2020-00306 NC Primary

Addresses

Primary practice location

1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204-2963

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone (704) 355-9330

Other practice location 2

2700 Providence Rd S
Ste 225
Waxhaw, NC 28173-6313
Phone (704) 863-8750

Other practice location 3

105 Yadkin St
Ste 101
Albemarle, NC 28001-3449
Phone (980) 323-5425

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200629001405 NC Practitioner - Orthopedic Surgery 2062719388 Reassigns benefits to 2 organizations
I20211210001868 CA Practitioner - Orthopedic Surgery 2062719388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of California, Irvine, California College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1011 Balwin Park Blvd
Baldwin Park, CA 91706-5806
Phone (626) 851-1011

1255 W Arrow Hwy
San Dimas, CA 91773-2340
Phone (909) 394-2526

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2020-00306NCMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 27, 2021 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jul 27, 2020 Accepting new patients
Carolinas Physicians Network Inc Orthopaedic Surgery CurrentSince Jul 27, 2020 Accepting new patients
Carolinas Medical Center Orthopaedic Surgery CurrentSince Jul 27, 2020 Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 27, 2021 Accepting new patients
Carolinas Medical Center CurrentSince Jul 27, 2020 Accepting new patients

Locations

1011 Baldwin Park Blvd
Baldwin Park, CA 91706
Phone (626) 851-1011

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

105 Yadkin St
Ste 101
Albemarle, NC 28001
Phone (704) 474-3171

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204
Phone (704) 355-1813

1100 Blythe Blvd
Charlotte, NC 28203
Phone (704) 355-4300

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

2700 S Providence Rd
Ste 225
Waxhaw, NC 28173
Phone (704) 667-6700

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1398038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1194145813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MOREHEAD MEDICAL DR",
            "address_2": "STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042963",
            "telephone_number": "704-355-5982"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Blythe Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035814",
            "country_code": "US",
            "telephone_number": "704-355-9330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2700 Providence Rd S",
            "address_2": "Ste 225",
            "address_purpose": "LOCATION",
            "city": "Waxhaw",
            "state": "NC",
            "postal_code": "281736313",
            "country_code": "US",
            "telephone_number": "704-863-8750",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 Yadkin St",
            "address_2": "Ste 101",
            "address_purpose": "LOCATION",
            "city": "Albemarle",
            "state": "NC",
            "postal_code": "280013449",
            "country_code": "US",
            "telephone_number": "980-323-5425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANZANO",
        "first_name": "GIVENCHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-21",
        "last_updated": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NC",
            "license": "2020-00306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1011 Baldwin Park Blvd",
            "city": "Baldwin Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917065806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.