NPIMap

Individual provider Active NPI

Manzur Moidunny, MD

  • Family Medicine Physician
  • Monroe, MI
National Provider Identifier
1689169872
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5315094447 Issued in MI
Practice address
650 Stewart Rd
Monroe, MI 48162-4222
Phone
(734) 240-8430
NPI assigned
Jun 29, 2018
Last updated
Feb 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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 5315094447 MI Primary

Addresses

Primary practice location

650 Stewart Rd
Monroe, MI 48162-4222

Mailing address

650 Stewart Rd
Monroe, MI 48162-4222
Phone (734) 240-8430

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mmoidunny132369@epicdirect.promedica.org
Direct Messaging Address mmoidunny775461@direct.centracare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MN, SC3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20210709000687 OH Practitioner - Family Practice 7416286067
I20231206000413 MN Practitioner - HospitalistPractitioner - Family Practice 7416286067 Reassigns benefits to 1 organization
I20251212001729 SC Practitioner - Hospitalist 7416286067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Family Practice
Education
Central Michigan College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians
24 On Physicians of SC LLCGroup PAC ID 5890127344, 136 clinicians

Practice addresses (Care Compare)

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

316 Calhoun St
Charleston, SC 29401-1113
Phone (843) 724-2901

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
24 On Physicians of SC, LLC CurrentSince Dec 1, 2025 Accepting new patients
Valiya Health Current Accepting new patients
Centracare Clinic CurrentSince Nov 1, 2023 Accepting new patients
Centracare Clinic CurrentSince Nov 1, 2023 Accepting new patients
St. Cloud Hospital Past Accepting new patients
Centracare Clinic Past Accepting new patients
Dr B Medical Group de PA Past Accepting new patients
DRH Medical Group Past Accepting new patients

Locations

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000

100 Callen Blvd
Summerville, SC 29486
Phone (845) 529-3165

Interoperability endpoints

  • Direct secure messaging: manzur.moidunny@297228672368644.direct.elationemr.com
  • Direct secure messaging: mmoidunny775461@direct.centracare.com

Organizations & group practices 9

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1530230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1689169872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 STEWART RD",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481624222",
            "telephone_number": "734-240-8430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 STEWART RD",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481624222",
            "telephone_number": "734-240-8430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOIDUNNY",
        "first_name": "MANZUR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-29",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5315094447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoidunny132369@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoidunny775461@direct.centracare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mmoidunny775461@direct.centracare.com",
            "address_1": "1200 6th Ave N",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563032735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

Verify at the official NPI Registry.