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DR. PHOUTPHONG MANIVONG DNP, ARPN, CRNA
NPI 1447130620
Nurse Anesthetist, Certified Registered in Saint Cloud, MN

Active since September 06, 2025PECOS EnrolledAccepts Medicare Assignment
5918 CRESTWOOD CT, SAINT CLOUD, MN 56301(320) 493-2757 Get Directions Write a Review

NPPES record last updated: December 1, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 1, 2025, Sep 6, 2025 (2 updates tracked since 2025).

About Dr. Phoutphong Manivong Dnp, Arpn, Crna NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. PHOUTPHONG MANIVONG DNP, ARPN, CRNA (NPI 1447130620) is an individual nurse anesthetist, certified registered in Saint Cloud, Minnesota, licensed in Minnesota (156072) and active in the NPI registry since September 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1447130620
Entity TypeIndividualFemale
Primary Taxonomy367500000X
Provider Legal NameDR. PHOUTPHONG MANIVONGCredential: DNP, ARPN, CRNA
Location Address5918 CRESTWOOD CTSaint Cloud, MN 56301-8850
Mailing Address5918 Crestwood CtSaint Cloud, MN 56301-8850
Phone(320) 493-2757
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateSeptember 6, 2025
Last NPPES UpdateDecember 1, 20252 updates tracked since enumeration
NPPES CertifiedDecember 1, 2025
✔ NPI 1447130620 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
License✔ Licensed in MN · 156072
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
5918 CRESTWOOD CT, Saint Cloud, MN 56301
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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

Dr. Phoutphong Manivong Dnp, Arpn, Crna 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.

PECOS PAC ID1456845015
PECOS Enrollment IDI20251210003859
Eligible to Order & Refer✔ Part B Labs & Imaging– Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Phoutphong Manivong reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

St Cloud Outpatient Surgery Ltd
8.0 mi
Ambulatory Surgical
1526 NORTHWAY DR
Saint Cloud, MN 56303
  • Reassigned Medicare billing, Minnesota enrollment
  • 40 clinicians in this Medicare group
NPI 1124084843 (320) 251-8385
Allina Health System
16 mi
Family Medicine
440 ELM ST E
Annandale, MN 55302
  • Reassigned Medicare billing, Minnesota enrollment
  • 3,733 clinicians in this Medicare group
NPI 1457657249 (320) 274-3744
Certified Anesthesia Care, Co.
74 mi
Nurse Anesthetist, Certified Registered
2950 CURVE CREST BLVD W
Stillwater, MN 55082
  • Reassigned Medicare billing, Minnesota enrollment
  • 131 clinicians in this Medicare group
NPI 1699736348 (888) 209-0305

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 56301 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$127.61 typical visit price
range $56.00 – $168.28
Typical copayment $31.90 (range $14.00 – $42.07)
Most-billed visit code 99204
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Phoutphong Manivong's NPI number?

The NPI number for Phoutphong Manivong is 1447130620. It was assigned to this individual provider in the NPPES registry on September 6, 2025.

Where is Phoutphong Manivong located?

Phoutphong Manivong practices at 5918 Crestwood Ct, Saint Cloud, MN 56301. The listed phone number is (320) 493-2757.

What is Phoutphong Manivong's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Phoutphong Manivong enrolled in Medicare?

Yes. Phoutphong Manivong 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 Phoutphong Manivong's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Phoutphong Manivong reassigns Medicare benefits to 3 organizations: St Cloud Outpatient Surgery Ltd (Saint Cloud, MN), Allina Health System (Annandale, MN) and Certified Anesthesia Care, Co. (Stillwater, MN). 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 Phoutphong Manivong's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Phoutphong Manivong was last updated on December 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.