Larry G. Manney, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

42337 Issued in MN

Practice address

17705 Hutchins Dr
Suite 101
Minnetonka, MN 55345-4145

Phone

(952) 401-8300

Fax

(952) 401-8246

NPI assigned

Mar 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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 Medicine

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 and National Provider Directory roles.

• South Lake Clinic, P.a.

  • Pediatrics Physician
  • Minnetonka, MN
  • NPI 1427027184
  Medicare reassignment NPD

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208908800000",
    "number": "1346217841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR",
            "address_2": "SUITE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454145",
            "telephone_number": "952-401-8300",
            "fax_number": "952-401-8246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR",
            "address_2": "SUITE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454145",
            "telephone_number": "952-401-8300",
            "fax_number": "952-401-8246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNEY",
        "first_name": "LARRY",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2008-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "42337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "649612100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claire Malark, APRN,CNP
• Tamara Malesev, NP
• Amber Malone, FNP
• Ann M Mann, MD
• Mary Nan Mann, LMT
• Michael Manning
• Grace Mans
• Judith Marayelle, M.S.ED., LP
• Judith Esther Marcus, LICSW
• Maren Schiess Rinker, LLC

• Pediatrics Physician in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; 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.