Physician Compare National (NPI:1407848971)

HEALTHCARE PROVIDER: JONATHAN LYLE MANZER M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1407848971
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5799765178
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040726000227
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MANZER
	Individual professional last name
Provider First Name	JONATHAN
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MANZER FAMILY MEDICINE LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	8628058013
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3071 S GRAND AVE
	Group Practice or individual's line 1 address
City	CARTHAGE
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	648367851
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4173584811
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	261338
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY HOSPITAL CARTHAGE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	260137
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	FREEMAN HEALTH SYSTEM-FREEMAN WEST
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	170203
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	PREMIER SURGICAL INSTITUTE
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	260001
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	MERCY HOSPITAL JOPLIN
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y