MANHOULY PHOUTHACHACK – Family Nurse Practitioner, NPI 1295965481
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,720 NURSE PRACTITIONER in MN
Provider Addresses for MANHOULY PHOUTHACHACK
920 2nd Ave S
Suite 400
Minneapolis, MN 554023318
Phone: (612) 225-1534
Type: Location
162 WASHINGTON AVE
NORTH HAVEN, CT 064731711
Phone: (866) 389-2727
Type: Mailing
839, Farmington Avenue, Bristol, Hartford County, Connecticut, 06010, United States
BRISTOL, CT 060103922
Phone: (866) 389-2727
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2009-09-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20090915000014 | I | Nurse Practitioner | CT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 87426 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | 30 | 27 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 23 | 23 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 23 | 22 | $0 |
| G0008 | Administration of influenza virus vaccine | 19 | 19 | $0 |
| 90694 | Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage | 18 | 18 | $0 |
Insurance plans in this area (ZIP 55402)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | CT | |
| - | CT | |
| Nurse Practitioner | CT | |
| Nurse Practitioner | CT | |
| - | CT | |
| - | CT | |
| Nurse Practitioner | CT | |
| - | CT | |
| Nurse Practitioner | CT | |
| Nurse Practitioner | CT |
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