DR. KOTI R MANNEM (MD) – Psychiatry Physician, NPI 1720188717
Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
677 PSYCHIATRY in WI
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Provider Addresses for DR. KOTI R MANNEM (MD)
3150, Gershwin Drive, Bay Highlands, Green Bay, Brown County, Wisconsin, 54311, United States
GREEN BAY, WI 543115859
Phone: (920) 391-4700
Fax: (920) 391-4870
Mailing address matches the actual address.
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: 2004-12-18
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 |
|---|---|---|---|---|
| I20041218000041 | I | Psychiatry | WI | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 369 | 115 | $0 |
| Q3014 | Telehealth originating site facility fee | 111 | 52 | $0 |
Insurance plans in this area (ZIP 54311)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Psychiatry, Addiction Medicine | NY | |
| Nurse Practitioner | WI | |
| Clinical Social Worker | WI | |
| Clinical Social Worker | WI | |
| Mental Health Counselor | WI | |
| P S Y C H I A T R Y | IL | |
| Nurse Practitioner | WI | |
| Mental Health Counselor | WI | |
| Clinical Psychologist | WI | |
| P S Y C H I A T R Y | WI |
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