Phyllis Johnna Manna, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2009013387 Issued in MO

Practice address

101 Skaggs Rd
Suite 302
Branson, MO 65616-2075

Phone

(417) 334-8288

Fax

(417) 334-6966

NPI assigned

Jun 3, 2009

Last updated

Oct 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO, AR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Branson Nephrology LLC

  • Nephrology Physician
  • Branson, MO
  • NPI 1427025212

  AR

  Medicare reassignment
• Branson Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Branson, MO
  • NPI 1588701239
  NPD (past)
• Branson Kidney Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Branson West, MO
  • NPI 1285109041
  NPD (past)
• Harrison Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Harrison, AR
  • NPI 1659522076
  NPD (past)

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

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1528294667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SKAGGS RD",
            "address_2": "SUITE 302",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656162075",
            "telephone_number": "417-334-8288",
            "fax_number": "417-334-6966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SKAGGS RD",
            "address_2": "SUITE 302",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656162075",
            "telephone_number": "417-334-8288",
            "fax_number": "417-334-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNA",
        "first_name": "PHYLLIS",
        "middle_name": "JOHNNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-03",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2009013387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen E Mackey, MS, PLPC
• Hervey Mac Madden, M.D.
• J Bradley Mahan, RPH
• Richard S Makuch, MD
• Robbie Thomas Mangalasseril, M.D.
• Peter R Marcellus, MD
• Ryan Michael Marlett
• Marshall Spinal Care, PC
• Matthew Marshall, FNP
• Matthew R Marshall

• Medical Physician Assistant in Branson, MO
• Providers in Branson, MO by specialty
• Medical Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; 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.