NPIMap

Organization Active NPI

Manzer Family Medicine, LLC

  • Family Medicine Physician
  • Carthage, MO
National Provider Identifier
1982731444
Registry record updated Nov 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2004001464 Issued in MO
Legal business name
MANZER FAMILY MEDICINE, LLC
Practice address
3071 S Grand Ave
Carthage, MO 64836-7851
Phone
(417) 358-4811
NPI assigned
Feb 28, 2007
Last updated
Nov 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2013

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

Authorized official

Name
Jonathan Lyle Manzer, M.D.NPI 1407848971
Title
Physician
Phone
(417) 358-4811

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2004001464 MO Primary

Addresses

Primary practice location

3071 S Grand Ave
Carthage, MO 64836-7851

Mailing address

3071 S Grand Ave
Carthage, MO 64836-7851
Phone (417) 358-4811

Other identifiers 1

IdentifierTypeStateIssuer
209288406MedicaidMO

Other names 1

  • Jonathan Manzer Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040726000283 MO Part B Supplier - Clinic/Group Practice 8628058013 Receives reassigned benefits from 6 practitioners
Practice locations: Carthage, MO
O20131202000802 KS Part B Supplier - Clinic/Group Practice 8628058013 Receives reassigned benefits from 16 practitioners
Practice locations: Columbus, KS; Galena, KS

National Provider Directory

National Provider Directory

Locations

1605 K66
Ste A
Galena, KS 66739
Phone (417) 310-9286

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385337600000",
    "number": "1982731444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3071 S GRAND AVE",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648367851",
            "telephone_number": "417-358-4811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3071 S GRAND AVE",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648367851",
            "telephone_number": "417-358-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANZER FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2013-11-25",
        "status": "A",
        "authorized_official_last_name": "MANZER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "LYLE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "417-358-4811",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2004001464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209288406",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jonathan Manzer",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Carthage, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.