Koti R Mannem · Psychiatry Physician

3150 Gershwin Drive, Green Bay, WI 54311-5859

Overview

Koti R Mannem is a Psychiatry Physician practicing in Green Bay, Wisconsin. The National Provider Identifier (NPI) is #1720188717, which was assigned on September 22, 2006, and the registration record was last updated on March 17, 2025. The practitioner's main practice location is at 3150 Gershwin Drive, Green Bay, WI 54311-5859; the contact telephone number is 9203914700, and the fax number is 9203914870. The primary taxonomy of Koti R Mannem is Psychiatry Physician (2084P0800X), with specialization in Psychiatry. Koti R Mannem is licensed to practice in the state of Wisconsin (#24001).

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

Provider Information

NPI 1720188717
Entity Type Individual
Provider Name DR. KOTI R MANNEM
Gender Male
Credential MD
Practice Address 3150 Gershwin Drive
Green Bay
WI 54311-5859
Practice Telephone 9203914700
Practice Fax Number 9203914870
Mailing Address 3150 Gershwin Drive
Green Bay
WI 54311-5859
Mailing Telephone 9203914700
Mailing Fax Number 9203914870
Certification Date 2025-03-17
Enumeration Date 2006-09-22
Last Update Date 2025-03-17
Is Sole Proprietor N

Doctor and Clinician Information

PAC ID 7911964200
Medicare Provider Enrollment and Chain/Ownership System (PECOS) Associate Control (PAC) ID
Full Name KOTI R MANNEM
Primary Specialty PSYCHIATRY
Organization Legal Name ONEIDA COUNTY
Address 705 E Timber Dr
Rhinelander
WI 54501-2859

Taxonomy and Licenses

PrimaryCodeClassificationSpecializationTaxonomy GroupLicense NumberLicense State
Y2084P0800XPsychiatry & NeurologyPsychiatry24001WI

Other Provider Identifiers

Other IdentifierIssuing StateIssuerIdentifier Type
1720188717WIMEDICAID

Taxonomy Information

Primary Taxonomy

Code 2084P0800X
Taxonomy Psychiatry Physician
Classification Psychiatry & Neurology
Specialization Psychiatry
Grouping Allopathic & Osteopathic Physicians
Definition: A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]

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Location Information

Street Address 3150 GERSHWIN DRIVE
City GREEN BAY
State WI
Zip Code 54311-5859
Country US

Providers in the same zip code

Provider NameAddressTaxonomyEnumeration Date
Taylor Lauren Shefchik · Taylor Smiley 2617 Development Dr, Green Bay, WI 54311-4240Physician Assistant2024-10-02
Carrie Kraemer 3150 Gershwin Dr, Green Bay, WI 54311-4328Clinical Social Worker2023-10-04
Jacinda J Hecker 3150 Gershwin Dr, Green Bay, WI 54311-4328Social Worker2024-07-09
Eric J Tarsi 2223 Lime Kiln Rd, Green Bay, WI 54311Physical Therapist2005-12-07
County of Brown 3150 Gershwin Dr, Green Bay, WI 54311-4328Case Management Agency2025-07-15
Tyler G Luedke 3150 Gershwin Dr, Green Bay, WI 54311-4328Addiction (Substance Use Disorder) Counselor2013-04-08
Jamie Lee Noxon · Jamie Lee Johnston 1496 Bellevue St # 101, Green Bay, WI 54311-4205Mental Health Counselor2020-10-26
Jenna R Mobile 3150 Gershwin Dr, Green Bay, WI 54311-4328Addiction (Substance Use Disorder) Counselor2026-01-31
Grace Woods 2605 Development Dr, Green Bay, WI 54311-4240Physician Assistant2025-09-03
Logan Wilz 3150 Gershwin Dr, Green Bay, WI 54311-4328Clinical Psychologist2023-09-25
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Dataset Information

This dataset includes over five million health care providers who are assigned National Provider Identifier (NPI) in the National Plan and Provider Enumeration System (NPPES), developed by the Centers for Medicare & Medicaid Services (CMS). Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under Health Insurance Portability and Accountability Act (HIPAA). Each provider is registered with the NPI, full name, status, address, taxonomy, other identifiers, etc.

Subject Transparency and Disclosure
Jurisdiction Federal
Data Provider National Plan and Provider Enumeration System (NPPES), by the Centers for Medicare & Medicaid Services (CMS)
Source download.cms.gov

Dataset Details

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers and all health plans and health care clearinghouses, who must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).

All health care providers who are HIPAA-covered entities, whether individuals or organizations, must get an NPI. A HIPAA-covered entity is a health care provider that conducts certain transactions in electronic form, or a health care clearinghouse, or a health plan (including commercial plans, Medicare, and Medicaid).

Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign unique identifiers to health care providers. The National Provider Indentifier (NPI) has been the standard identifier for all HIPAA-covered entities (health care providers) since May 23, 2007. Small health plans were required to obtain and use an NPI by May 23, 2008.

This dataset includes over five million health care providers (individuals and organizations) who are assigned NPI. The provider data elements are disclosed to the public by the Centers for Medicare & Medicaid Services (CMS) under the Freedom of Information Act (FOIA), as listed in the NPPES Data Dissemination Notice (CMS-6060-N). The NPI final rules define the following elements which required to be disclosed as determined by Department of Health & Human Services (HHS): NPI, Entity Type, Provider Name, Credential, Business Mailing Address, Business Location Address, Healthcare Provider Taxonomy Code, Other Provider Identifier, Provider Enumeration Date, NPI Deactivation Date, Provider License Number, Authorized Official Name and Contact Information.