Gary J Mansheim, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22274 Issued in IA

Practice address

1201 W Agency Rd
West Burlington, IA 52655-1645

Phone

(319) 754-4242

NPI assigned

Nov 24, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Great River Medical Services

  • Family Medicine Physician
  • West Burlington, IA
  • NPI 1417025230
  NPD (past)

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193097600000",
    "number": "1669548541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 W AGENCY RD",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551645",
            "telephone_number": "319-754-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W AGENCY RD",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551645",
            "telephone_number": "319-754-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSHEIM",
        "first_name": "GARY",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-24",
        "last_updated": "2007-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "22274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2192534",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Milind Ramesh Limaye, D.O.
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• Lowell Kent Long, D.D.S.
• Luxottica Retail North America Inc
• Dean P Lyons, M.D.
• Kimberly A Marshall, M.D.
• Laura Lee Martin, W.H.N.P.
• Michael Steven Mathews, DDS
• Michaela Paige Mathews
• Donald R McCabe, M.D.

• Family Medicine Physician in West Burlington, IA
• Providers in West Burlington, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.