NPIMap

Individual provider Active NPI

Jonathan Lyle Manzer, M.D.

  • Family Medicine Physician
  • Carthage, MO
National Provider Identifier
1407848971
Registry record updated Sep 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2004001464 Issued in MO
Practice address
3071 S Grand Ave
Carthage, MO 64836-7851
Phone
(417) 358-4811
Fax
(417) 358-4781
NPI assigned
Aug 19, 2005
Last updated
Sep 16, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2004001464 MO Primary

Addresses

Primary practice location

3071 S Grand Ave
Carthage, MO 64836-7851

Mailing address

3071 S Grand Ave
Carthage, MO 64836-7851
Phone (417) 358-4811

Other identifiers 1

IdentifierTypeStateIssuer
209288406MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 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
I20040726000227 MO Practitioner - Family Practice 5799765178 Reassigns benefits to 2 organizations
I20131202001082 KS Practitioner - Family Practice 5799765178 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
McPherson Medical and Diagnostic LLCGroup PAC ID 5698773539, shared by 11 NPIs, 88 clinicians

Practice addresses (Care Compare)

1605
Galena, KS 66739-4306
Phone (417) 310-9286

216 W Main St
Steele, MO 63877-1436
Phone (573) 695-2181

223 S 3Rd St
Hayti, MO 63851-1617
Phone (573) 717-1072

3071 S Grand Ave
Carthage, MO 64836-7851
Phone (417) 310-9286

433 S Garrison Ave
American Medical Missouri
Carthage, MO 64836-1749
Phone (417) 359-8646

915 W Maple St
Columbus, KS 66725-1508
Phone (417) 310-9288

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions54
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McPherson Medical & Diagnostic, LLC Current Accepting new patients
McPherson Medical & Diagnostic, LLC Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
McPherson Medical & Diagnostic LLC CurrentSince Sep 1, 2023 Accepting new patients
McPherson Medical & Diagnostic LLC Current Accepting new patients
McPherson Medical & Diagnostic LLC CurrentSince Sep 1, 2023 Accepting new patients
Manzer Family Medicine, LLC Family Medicine CurrentSince Feb 27, 2004 Accepting new patients
Eastview Manor, Inc. Past Accepting new patients
McPherson Medical & Diagnostic, LLC Family Medicine Past Accepting new patients
Anew Healthcare Operations - Sarcoxie, LLC Past Accepting new patients
Sarcoxie Health Care Center, L.L.C. Past Accepting new patients
Edgewood Manor Health Care Center, L.L.C. Past Accepting new patients
Nathan Richard Health Care Center, LLC Past Accepting new patients
Bridgewood Health Care Center, L.L.C. Past Accepting new patients
Nick's Health Care Center LLC Past Accepting new patients
Gregory Ridge Health Care Center, L.L.C. Past Accepting new patients

Locations

915 W Maple St
Columbus, KS 66725
Phone (417) 310-9286

1605 K66
Ste A
Galena, KS 66739
Phone (417) 310-9286

1515 Hazel Ave
Ste 101
Carthage, MO 64836
Phone (417) 358-0188

3071 S Grand Ave
Carthage, MO 64836
Phone (417) 310-9286

304 Teaco Rd
Ste A
Kennett, MO 63857
Phone (573) 559-3591

216 W Main St
Steele, MO 63877
Phone (573) 695-2181

216 W Main St
Ste B
Steele, MO 63877
Phone (573) 695-2181

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Holton Health Care CenterHolton, KS, CCN 175435 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 25, 2025
Jan 25, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379289600000",
    "number": "1407848971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3071 S GRAND AVE",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648367851",
            "telephone_number": "417-358-4811",
            "fax_number": "417-358-4781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3071 S GRAND AVE",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648367851",
            "telephone_number": "417-358-4811",
            "fax_number": "417-358-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZER",
        "first_name": "JONATHAN",
        "middle_name": "LYLE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2013-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2004001464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209288406",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, MO

Sources for this page

Verify at the official NPI Registry.