MANHOULY PHOUTHACHACK
NPI 1295965481
Nurse Practitioner - Family in Bristol, CT
About Manhouly Phouthachack NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MANHOULY PHOUTHACHACK (NPI 1295965481) is an individual family provider in Bristol, Connecticut, licensed in Connecticut (004098) and active in the NPI registry since July 2009. She is enrolled in Medicare PECOS, maintains a secondary practice location in Minneapolis, and is a graduate of Other (2007).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Manhouly Phouthachack is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Manhouly Phouthachack reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Rocky Hill, CT 06067
- Reassigned Medicare billing, Connecticut enrollment
- 62 clinicians in this Medicare group
Rocky Hill, CT 06067
- Reassigned Medicare billing, Connecticut enrollment
- 124 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 4
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 06010 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 12
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Manhouly Phouthachack's NPI number?
The NPI number for Manhouly Phouthachack is 1295965481. It was assigned to this individual provider in the NPPES registry on July 22, 2009.
Where is Manhouly Phouthachack located?
Manhouly Phouthachack practices at 839 Farmington Ave, Bristol, CT 06010. The listed phone number is (866) 389-2727.
What is Manhouly Phouthachack's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Manhouly Phouthachack enrolled in Medicare?
Yes. Manhouly Phouthachack is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Manhouly Phouthachack's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Manhouly Phouthachack reassigns Medicare benefits to 2 organizations: Minuteclinic Primary Care Connecticut PLLC (Rocky Hill, CT) and Mc Diagnostic Of Connecticut, P.C. (Rocky Hill, CT). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Manhouly Phouthachack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Manhouly Phouthachack accept?
Health plans from Anthem Blue Cross and Blue Shield list Manhouly Phouthachack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Manhouly Phouthachack was last updated on May 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Manhouly Phouthachack · NPI 1295965481
Family physician in Bristol, Connecticut. Individual provider, active in the CMS NPPES registry since July 22, 2009.
## Identity
- **NPI:** 1295965481 (Entity type: Individual)
- **Enumerated:** July 22, 2009
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 004098 (Connecticut)
- **Sole proprietor:** No
## Practice location
- **Address:** 839 FARMINGTON AVE, Bristol, CT 06010-3922
- **Phone:** (866) 389-2727
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Minuteclinic Primary Care Connecticut PLLC (NPI 1548076086, Rocky Hill, CT); Mc Diagnostic Of Connecticut, P.C. (NPI 1386821932, Rocky Hill, CT) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2007
## Record status
- **NPPES last updated:** May 16, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1295965481) · Data from the CMS NPPES public registry.