Individual provider Active NPI

Manel Menaka Karunasiri, M.D.

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1275743163
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
U0372 Issued in TX
Practice address
4502 Medical Dr
San Antonio, TX 78229-4402
Phone
(210) 358-4000
NPI assigned
May 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 017972 ME
Pediatrics Physician 208000000X A88971 CA
Neonatal-Perinatal Medicine Physician 2080N0001X A88971 CA
Pediatrics Physician 208000000X U0372 TX Primary

Addresses

Primary practice location

4502 Medical Dr
San Antonio, TX 78229-4402

Mailing address

PO Box 40
Caribou, ME 04736-0040
Phone (207) 498-2359

Other practice location 1

163 Van Buren Rd
Caribou, ME 04736-3567
Phone (207) 492-3451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME, TX2 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
I20191008003011 ME Practitioner - Pediatric Medicine 8921339888 Reassigns benefits to 1 organization
I20231206003266 TX Practitioner - Pediatric Medicine 8921339888 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
017972MEMDPediatrics Physician
U0372TXMDPediatrics Physician
A88971CAMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medicine Associates Pediatrics CurrentSince Oct 28, 2023 Accepting new patients
Pines Health Services CurrentSince Aug 21, 2019 Accepting new patients
Pines Health Services Pediatrics CurrentSince Aug 21, 2019 Accepting new patients
City of Caribou Past Accepting new patients

Locations

163 Van Buren Rd
Ste 1
Caribou, ME 04736
Phone (207) 498-1227

163 Van Buren Rd
Caribou, ME 04736
Phone (207) 498-1320

74 Access Hwy
Caribou, ME 04736
Phone (207) 498-2350

2121 SW 36th St
San Antonio, TX 78237
Phone (210) 358-5100

4502 Medical Dr
San Antonio, TX 78229
Phone (210) 358-3555

903 W Martin St
#492
San Antonio, TX 78207
Phone (210) 358-3441

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1275743163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "CARIBOU",
            "state": "ME",
            "postal_code": "047360040",
            "telephone_number": "207-498-2359",
            "fax_number": "207-498-3947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 MEDICAL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294402",
            "telephone_number": "210-358-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "163 Van Buren Rd",
            "address_purpose": "LOCATION",
            "city": "Caribou",
            "state": "ME",
            "postal_code": "047363567",
            "country_code": "US",
            "telephone_number": "207-492-3451",
            "fax_number": "207-498-1697",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KARUNASIRI",
        "first_name": "MANEL",
        "middle_name": "MENAKA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ME",
            "license": "017972",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A88971",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "A88971",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "U0372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.