Manivanh A Prudhomme, MSN, FNP-BC, AGACNP- - Medicare Nurse Practitioner in Vicksburg, MS

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Manivanh A Prudhomme, MSN, FNP-BC, AGACNP- is a medicare enrolled "Nurse Practitioner - Family" in Vicksburg, Mississippi. She graduated from nursing school in 2020 and has 4 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Quad Intermed Company Llc and her current practice location is 2011 Highway 61 N, Vicksburg, Mississippi. You can reach out to her office (for appointments etc.) via phone at (014) 562-2776.

Manivanh A Prudhomme is licensed to practice in Mississippi (license number 904068) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1144831140.

Contact Information

Manivanh A Prudhomme, MSN, FNP-BC, AGACNP-
2011 Highway 61 N,
Vicksburg, MS 39183-3918
(014) 562-2776
(601) 456-2622

Map and Direction




Provider's Profile

Full NameManivanh A Prudhomme
GenderFemale
SpecialityNurse Practitioner
Experience4 Years
Location2011 Highway 61 N, Vicksburg, Mississippi
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Manivanh A Prudhomme graduated from nursing school in 2020
  NPI Data:
  • NPI Number: 1144831140
  • Provider Enumeration Date: 08/12/2020
  • Last Update Date: 07/13/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 0648690842
  • Enrollment ID: I20201008002132

Medical Identifiers

Medical identifiers for Manivanh A Prudhomme such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1144831140NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LF0000XNurse Practitioner - Family 904068 (Mississippi)Primary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Quad Intermed Company Llc670924595450

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Manivanh A Prudhomme allows following entities to bill medicare on her behalf.
Entity NameMea Primary Care Plus, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1750826210
PECOS PAC ID: 0941583728
Enrollment ID: O20170202001116
Entity NameRiverbend Healthcare Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1417620071
PECOS PAC ID: 4688071335
Enrollment ID: O20210922001433
Entity NameQuad Intermed Company Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1952099913
PECOS PAC ID: 6709245954
Enrollment ID: O20230706000437

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Manivanh A Prudhomme is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Manivanh A Prudhomme, MSN, FNP-BC, AGACNP-
2011 Highway 61 N,
Vicksburg, MS 39183

Ph: (601) 456-2277		Manivanh A Prudhomme, MSN, FNP-BC, AGACNP-
2011 Highway 61 N,
Vicksburg, MS 39183-3918

Ph: (014) 562-2776

Reviews and Comments


Nurse Practitioner Nurses in Vicksburg, MS

Mrs. Brittany Sharda Barnes, NURSE PRACTITIONER
Nurse Practitioner
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Practice Location: 919 Mission 66, Vicksburg, MS 39183
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Mrs. Kimberly Fuller, MSN, ACNP - BS
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Mrs. Latasha Jackson Claiborne, PMHNP
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Practice Location: 3444 Wisconsin Ave, Vicksburg, MS 39180
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Nina Tomlinson,
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Practice Location: 807 Monroe St, Vicksburg, MS 39183
Phone: 601-636-4356    
Linda Cheslek,
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Medicare: Not Enrolled in Medicare
Practice Location: 807 Monroe St, Vicksburg, MS 39183
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Medicare: Medicare Enrolled
Practice Location: 4077 Pemberton Square Blvd, Vicksburg, MS 39180
Phone: 601-638-8600    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.