Active NPI
Manar Edriss, M.D.
- Dermatology Physician
- Oklahoma City, OK
National Provider Identifier
1740930619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 43054
- Practice address
- 1000 NE 13TH St Ste 1C
Oklahoma City, OK 73104-5040 - Phone
- (405) 271-6110
- NPI assigned
- Mar 24, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MI | ||
| Dermatology Physician | 207N00000X | 43054 | OK | Primary |
Addresses
Primary practice location
1000 NE 13TH St Ste 1C
Oklahoma City, OK 73104-5040
Mailing address
7350 Orchard Ave
Dearborn, MI 48126-1310
Phone (313) 663-0904
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240730003753 | OK | Order and Referring Only - Dermatology | 8325428741 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43054 | OK | MD | Dermatology Physician |
Interoperability endpoints
- medriss1849639@direct.trinity-health.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727222400000",
"number": "1740930619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7350 ORCHARD AVE",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481261310",
"telephone_number": "313-663-0904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 NE 13TH ST STE 1C",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731045040",
"telephone_number": "405-271-6110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDRISS",
"first_name": "MANAR",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-24",
"last_updated": "2024-09-25",
"certification_date": "2024-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": null,
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OK",
"license": "43054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.