NPIMap

Individual provider Active NPI

Panneer Selvan Manickam, MD

  • Internal Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1861592511
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2016-02003 Issued in NC
Practice address
1381 Westgate Center Dr
Winston Salem, NC 27103-2934
Phone
(336) 718-0100
NPI assigned
Sep 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 43289 WI
Internal Medicine Physician 207R00000X 2016-02003 NC Primary

Addresses

Primary practice location

1381 Westgate Center Dr
Winston Salem, NC 27103-2934

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 718-4820

Other identifiers 1

IdentifierTypeStateIssuer
34088600MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pmanickam412758@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20161214001294 NC Practitioner - Internal Medicine 8820129646 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

1381 Westgate Ctr Dr
Winston Salem, NC 27103-2934
Phone (336) 718-0100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2016-02003NCMDInternal Medicine Physician
43289WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital Inc Internal Medicine CurrentSince Oct 28, 2022 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Oct 28, 2022 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

1381 Westgate Center Dr
Winston Salem, NC 27103
Phone (336) 718-0100

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1861592511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-718-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1381 WESTGATE CENTER DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032934",
            "telephone_number": "336-718-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANICKAM",
        "first_name": "PANNEER",
        "middle_name": "SELVAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "43289",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2016-02003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34088600",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pmanickam412758@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1381 Westgate Center Dr",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271032934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.