Individual provider Active NPI

Lyssa Bea Manares

  • Physical Therapist
  • Milwaukee, WI
National Provider Identifier
1851893978
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
14085-24 Issued in WI
Practice address
5790 S 27TH St
Milwaukee, WI 53221-4129
Phone
(414) 817-3701
NPI assigned
Mar 5, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 14085-24 WI Primary

Addresses

Primary practice location

5790 S 27TH St
Milwaukee, WI 53221-4129

Mailing address

6724 N Sidney PL Apt 107
Glendale, WI 53209-3253

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250527003204 CA Practitioner - Physical Therapist in Private Practice 1658890215 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14085-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Mar 10, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince Mar 10, 2025 Accepting new patients

Locations

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1520208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1851893978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6724 N SIDNEY PL APT 107",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532093253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5790 S 27TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532214129",
            "telephone_number": "414-817-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANARES",
        "first_name": "LYSSA BEA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-05",
        "last_updated": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "14085-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6041 Cadillac Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900341702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.