Theodore Bergen Manny Jr., M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

2012-00902 Issued in NC

Practice address

509 N Elam Ave FL 2
Greensboro, NC 27403-1157

Phone

(336) 274-1114

Fax

(336) 274-9638

NPI assigned

Nov 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Ted Bergen Manny Jr. Other name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Urology

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Piedmont Stone Center PLLCGroup PAC ID 2961315718, 71 clinicians

Urology Specialists of the Carolinas PLLCGroup PAC ID 0648178020, 78 clinicians

Alliance Urology SpecialistsGroup PAC ID 8921902586, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Moses H. Cone Memorial Hospital, the Hospital, Greensboro, NC, CCN 340091

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Piedmont Stone Center PLLC

  • Lithotripsy Clinic/Center
  • Winston-Salem, NC
  • NPI 1700827409

  Urology

  Medicare reassignment Care Compare group NPD
• Urology Specialists of the Carolinas PLLC

  • Urology Physician
  • Greensboro, NC
  • NPI 1346204088
  Medicare reassignment Care Compare group NPD
• Urology Specialists of the Carolinas PLLC

  • Urology Physician
  • Charlotte, NC
  • NPI 1669404208
  Medicare reassignment Care Compare group NPD
• Moses Cone Physician Services Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Reidsville, NC
  • NPI 1780004556
  Medicare reassignment NPD
• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Moses H. Cone Memorial Hospital Operating Corporation

  • General Acute Care Hospital
  • Greensboro, NC
  • NPI 1477591055
  Care Compare affiliation

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1871773143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 N ELAM AVE FL 2",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031157",
            "telephone_number": "336-274-1114",
            "fax_number": "336-232-5325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 N ELAM AVE FL 2",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031157",
            "telephone_number": "336-274-1114",
            "fax_number": "336-274-9638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNY",
        "first_name": "THEODORE",
        "middle_name": "BERGEN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-05",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "2012-00902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5921067",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TED",
            "last_name": "MANNY",
            "middle_name": "BERGEN",
            "prefix": "DR.",
            "suffix": "JR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Erica Chanel Manning
• Jimmy B. Manning, OTR/L, CHT
• Matthew A Manning, MD
• Bethany Mannion, LCMHC
• Julia Sodeman Manny, M.D.
• Eric A Mansell, MD
• Jessie Lauren Manthey, OTRL
• Emily K Manton
• Map Transport LLC
• Tavien Mapp, MD

• Urology Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Urology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.