NPIMap

Individual provider Active NPI

Tyler Dean Manley, DO

  • Family Medicine Physician
  • Marinette, WI
National Provider Identifier
1740708361
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
71461 Issued in WI
Practice address
2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone
(715) 735-5225
Fax
(715) 735-5388
NPI assigned
Sep 4, 2017
Last updated
Jun 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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 71461 WI Primary

Addresses

Primary practice location

2820 Roosevelt Rd
Marinette, WI 54143-3834

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

Other practice location 1

515 22nd Ave
Monroe, WI 53566-1569
Phone (608) 863-0073

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tmanley9279@direct.monroeclinic.org Direct
FHIR URL https://webproxyprd.monroeclinic.org/FHIR-PRD/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191230002133 WI Practitioner - Family Practice 4688949555 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

1630 Commanche Ave
Suite 102
Green Bay, WI 54313-5753
Phone (920) 433-6000

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Family Medicine CurrentSince Oct 1, 2024 Accepting new patients
Oconto Hospital & Medical Center Inc Family Medicine CurrentSince Nov 4, 2020 Accepting new patients
Bellin Memorial Hospital Inc Family Medicine CurrentSince Oct 1, 2024 Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
The Monroe Clinic, Inc. CurrentSince Dec 17, 2019 Accepting new patients
Oconto Hospital & Medical Center Inc Family Medicine CurrentSince Nov 4, 2020 Accepting new patients
Bellin Memorial Hospital Inc Family Medicine Current Accepting new patients
The Monroe Clinic, Inc. CurrentSince Dec 17, 2019 Accepting new patients

Locations

1630 Commanche Ave
Ste 102
Green Bay, WI 54313
Phone (920) 433-6000

3263 Eaton Rd
Ste 1
Green Bay, WI 54311
Phone (920) 433-6000

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

744 S Webster Ave
Fl 7
Green Bay, WI 54301

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Interoperability endpoints

  • Direct secure messaging: tmanley301378@direct.thedacare.org
  • Direct secure messaging: tmanley925320@direct.emplifyhealth.org

Organizations & group practices 8

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 8

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": "1504483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1740708361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 ROOSEVELT RD",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433834",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 22nd Ave",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "WI",
            "postal_code": "535661569",
            "country_code": "US",
            "telephone_number": "608-863-0073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANLEY",
        "first_name": "TYLER",
        "middle_name": "DEAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-04",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "71461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmanley9279@direct.monroeclinic.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "tmanley9279@direct.monroeclinic.org",
            "address_1": "515 22nd Ave",
            "city": "Monroe",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535661569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://webproxyprd.monroeclinic.org/FHIR-PRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "515 22nd Ave",
            "city": "Monroe",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535661569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marinette, WI

Sources for this page

Verify at the official NPI Registry.