Active NPI
Robert Manis, M.D.
- Family Medicine Physician
- Mena, AR
National Provider Identifier
1881682235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- C4843
- Practice address
- 400 Crestwood Cir
Mena, AR 71953-5512 - Phone
- (479) 394-3887
- Fax
- (479) 394-7758
- NPI assigned
- Oct 10, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C4843 | AR | Primary |
Addresses
Primary practice location
400 Crestwood Cir
Mena, AR 71953-5512
Mailing address
PO Box 295
Lockesburg, AR 71846-0295
Phone (870) 289-5865
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12711000000 | Other | AR | QUALCHOICE |
| 53296 | Other | AR | BCBS |
| 102561001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C4843 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
| Ouachita Family Practice LLC | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GFIEAD
Organizations & group practices 2
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": "1128902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265587200000",
"number": "1881682235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 295",
"city": "LOCKESBURG",
"state": "AR",
"postal_code": "718460295",
"telephone_number": "870-289-5865",
"fax_number": "870-289-6993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 CRESTWOOD CIR",
"city": "MENA",
"state": "AR",
"postal_code": "719535512",
"telephone_number": "479-394-3887",
"fax_number": "479-394-7758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANIS",
"first_name": "ROBERT",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-10",
"last_updated": "2010-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AR",
"license": "C4843",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALCHOICE",
"identifier": "12711000000",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "53296",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102561001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mena, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.