| Manuel R Moran, MD | |
|
1027 Washington Ave, Detroit Lakes, MN 56501-3409 | |
| (218) 847-5611 | |
| Not Available |
| Full Name | Manuel R Moran |
|---|---|
| Gender | Male |
| Speciality | General Surgery |
| Experience | 34 Years |
| Location | 1027 Washington Ave, Detroit Lakes, Minnesota |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811965775 | NPI | - | NPPES |
| 62D72MO | Other | MN | BCBSM |
| 005226400 | Medicaid | MN | |
| 1700230 | Other | MN | MEDICA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208C00000X | Colon & Rectal Surgery | 34332 (Minnesota) | Secondary |
| 208600000X | Surgery | 34332 (Minnesota) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Essentia Health St Marys - Detroit Lakes | Detroit lakes, MN | Hospital |
| Essentia Health Fosston | Fosston, MN | Hospital |
| Essentia Health Fargo | Fargo, ND | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| St Marys Regional Health Center | 2062326820 | 190 |
| Simplicity Health Pa | 1557617354 | 16 |
| Entity Name | St Marys Regional Health Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1679561088 PECOS PAC ID: 2062326820 Enrollment ID: O20031117000090 |
| Entity Name | First Care Medical Services |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073638565 PECOS PAC ID: 3678542842 Enrollment ID: O20040927000035 |
| Entity Name | First Care Medical Services |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1497850119 PECOS PAC ID: 3678542842 Enrollment ID: O20060504000670 |
| Entity Name | Simplicity Health PA |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780186486 PECOS PAC ID: 1557617354 Enrollment ID: O20180710001022 |
| Mailing Address | Practice Location Address |
|---|---|
| Manuel R Moran, MD 1702 University Dr S, Fargo, ND 58103-4940 Ph: Not Available | Manuel R Moran, MD 1027 Washington Ave, Detroit Lakes, MN 56501-3409 Ph: (218) 847-5611 |
George A Portilla, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1027 Washington Ave, Detroit Lakes, MN 56501 Phone: 218-847-5611 Fax: 218-847-0881 |
Mitchell B Goldstein, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1245 Washington Ave, Detroit Lakes, MN 56501 Phone: 218-846-2000 Fax: 218-846-2114 |
Randall J. Bolar, M.D. Surgery Medicare: Medicare Enrolled Practice Location: 1027 Washington Ave, Detroit Lakes, MN 56501 Phone: 218-847-5611 Fax: 218-847-0881 |
Shang-yee S Yeh, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1027 Washington Ave, Detroit Lakes, MN 56501 Phone: 218-844-2347 |