Manali Amin
Individual provider Active NPI Nurse Practitioner · Shawano, WI
NPI 1699423574 · NPPES record last updated Apr 28, 2022
Key facts
- NPI
- 1699423574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 11808 (WI)
- Practice address
- 100 County Road B
Shawano, WI 54166-7072 - Phone
- (715) 526-8270
- NPI assigned
- Mar 10, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1163 S Milwaukee Ave
Libertyville, IL 60048-3716
N8995 County Rd DK
Luxemburg, WI 54217-9677
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220328002355 | WI | Practitioner - Nurse Practitioner | 2264827336 | Reassigns benefits to 1 organization |
| I20260507002707 | IL | Practitioner - Nurse Practitioner | 2264827336 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 251900 | WI | MD | Registered Nurse |
| 11808 | WI | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 251900 | WI | |
| Nurse Practitioner | 363L00000X | 11808 | WI | Yes |
Addresses
Primary practice location
100 County Road B
Shawano, WI 54166-7072
Mailing address
3 Neenah Ctr
Neenah, WI 54956-3070
Phone (715) 526-8270
Other practice location 1
3221 Voyager Dr
Green Bay, WI 54311-8349
Phone (920) 256-0392
Other providers in Shawano, WI
- 1 Vision S.C.
- Advanced Physical Therapy & Sports Medicine of Shawano LLC
- Advanced Physical Therapy & Sports Medicine of Shawano LLC
- Patricia R Ainsworth
- Ambulatory Foot Surgery Center LTD
- Renee Anderson
- Christa M Andrews-Fike
- Sean Angle
- Appleton Audiology Associates, LLC
- Jeannette Theresa Arias-Flynn
All providers in Shawano, WI · Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.