Manuel A Proenza, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

142414 Issued in MT

Practice address

1101 26TH St S
Great Falls, MT 59405-5161

Phone

(406) 731-8888

Fax

(406) 731-8318

NPI assigned

Jun 15, 2012

Last updated

Jun 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Benefis Hospitals Inc

  dba Benefis Medical Group

  • Multi-Specialty Clinic/Center
  • Great Falls, MT
  • NPI 1780968974
  Medicare reassignment NPD
• Benefis Hospitals, Inc.

  • General Acute Care Hospital
  • Great Falls, MT
  • NPI 1881650737
  NPD
• Trinity Regional Medical Center

  dba UnityPoint Clinic

  • Emergency Medicine Physician
  • Fort Dodge, IA
  • NPI 1073594156
  NPD (past)

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

{
    "created_epoch": "1339718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1336401256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6010",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594066010",
            "telephone_number": "406-731-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 26TH ST S",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594055161",
            "telephone_number": "406-731-8888",
            "fax_number": "406-731-8318"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2704 N Tenaya Way",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891280424",
            "country_code": "US",
            "telephone_number": "702-877-5199",
            "fax_number": "702-459-0402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2720 10th Ave S",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "MT",
            "postal_code": "594053240",
            "country_code": "US",
            "telephone_number": "406-731-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROENZA",
        "first_name": "MANUEL",
        "middle_name": "A",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-15",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "DO1964",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MT",
            "license": "142414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Public Drug Co

• Pediatrics Physician in Great Falls, MT
• Providers in Great Falls, MT by specialty
• Pediatrics Physician in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; 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.

Verify at the official NPI Registry.