NPIMap

Individual provider Active NPI

Derrick Anthony Manzlak, M.D.

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Anchorage, AK
National Provider Identifier
1235429457
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X
License
0101262628 Issued in VA
Practice address
3976 University Lake Dr Ste 100
Anchorage, AK 99508-4644
Phone
(907) 729-8141
Fax
(907) 729-3998
NPI assigned
Apr 8, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 261728 MA
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 0101262628 VA Primary

Addresses

Primary practice location

3976 University Lake Dr Ste 100
Anchorage, AK 99508-4644

Mailing address

3976 University Lake Dr Ste 100
Anchorage, AK 99508-4644
Phone (907) 729-8141

Other practice location 1

1101 Sam Perry Blvd Ste 411
Fredericksburg, VA 22401-4466
Phone (540) 741-7846

Other practice location 2

1 Boston Medical Ctr Pl
Boston, MA 02118-2908
Phone (617) 414-5245

Other identifiers 1

IdentifierTypeStateIssuer
1235429457MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170829000432 VA Practitioner - Sleep MedicinePractitioner - Neurology 5799099651
I20200316000223 TX Practitioner - Sleep Medicine 5799099651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sleep Medicine
Education
Eastern Virginia Medical School, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3801 University Lake Dr
Anchorage, AK 99508-4658
Phone (907) 563-2662

3900 Ambassador Dr
Anchorage, AK 99508-5922
Phone (907) 563-2662

3976 University Lake Dr
Suite 100
Anchorage, AK 99508-4644
Phone (907) 563-2662

4315 Diplomacy Dr
Anchorage, AK 99508-5926
Phone (907) 563-2662

4320 Diplomacy Dr
Anchorage, AK 99508-5925
Phone (907) 265-4955

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
261728MAMDPsychiatry Physician
0101262628VAMDSleep Medicine (Psychiatry & Neurology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alaska Native Tribal Health Consortium CurrentSince Mar 1, 2020 Accepting new patients

Locations

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

4000 Ambassador Dr
Anchorage, AK 99508
Phone (907) 729-1900

3976 University Lake Dr
Ste 100
Anchorage, AK 99508
Phone (907) 729-8141

Interoperability endpoints

  • Direct secure messaging: damanzlak@direct.anthc.org

Organizations & group practices 1

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1302220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1235429457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3976 UNIVERSITY LAKE DR STE 100",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084644",
            "telephone_number": "907-729-8141",
            "fax_number": "907-729-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3976 UNIVERSITY LAKE DR STE 100",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084644",
            "telephone_number": "907-729-8141",
            "fax_number": "907-729-3998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Sam Perry Blvd Ste 411",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "VA",
            "postal_code": "224014466",
            "country_code": "US",
            "telephone_number": "540-741-7846",
            "fax_number": "540-741-1632",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Boston Medical Ctr Pl",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021182908",
            "country_code": "US",
            "telephone_number": "617-414-5245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANZLAK",
        "first_name": "DERRICK",
        "middle_name": "ANTHONY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-08",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "261728",
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "VA",
            "license": "0101262628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235429457",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.