Doctor profile · Federal record
Dr. Manivanh Prudhomme, MSN, FNP-BC, AGACNP-
Family Nurse Practitioner (CMS: Nurse Practitioner) · Vicksburg, MS
- NPI 1144831140
- Accepts Medicare
- MIPS 87.6 / 100 · 2023
- 6 yrs in practice
- Female
- Group practice
- No sanctions
Practice & contact
- Primary practice
-
2011 Highway 61 N
Vicksburg, MS 391833918
(014) 562-2776
fax (601) 456-2622
Credentials & registration
- NPI registered
- August 2020 — 6 yrs on file
- Profile last updated
- July 13, 2021
- Year of graduation
- 2020 — 6 yrs since
- Specialty taxonomy
- 363LF0000X — NUCC code
- State license (1)
- Mississippi #904068
Federal sanctions & exclusions
No sanctions, exclusions or revocations on file
Checked against OIG LEIE on NPI 1144831140. Last verified May 11, 2026.Medicare procedures · 2023
Top services delivered
Total services
1,684
Distinct HCPCS
10
Medicare allowed
$41,972
| HCPCS | Description | Services | Patients | Avg allowed | |
|---|---|---|---|---|---|
J0696 |
Injection, ceftriaxone sodium, per 250 mg | 369 | 86 | $0 | |
J1100 |
Injection, dexamethasone sodium phosphate, 1 mg | 356 | 72 | $0 | |
99214 |
Established patient office or other outpatient visit, 30-39 minutes | 190 | 172 | $98 | |
96372 |
Injection of drug or substance under skin or into muscle | 173 | 115 | $11 | |
99213 |
Established patient office or other outpatient visit, 20-29 minutes | 110 | 98 | $68 | |
87426 |
Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | 65 | 63 | $35 | |
J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg | 59 | 20 | $0 | |
J1885 |
Injection, ketorolac tromethamine, per 15 mg | 56 | 15 | $1 | |
87400 |
Detection test by immunoassay technique for influenza virus | 55 | 28 | $14 | |
87804 |
Detection test by immunoassay with direct visual observation for influenza virus | 44 | 22 | $16 |
In context: peer comparison
Among 14 peers in this city , average services per provider: 90. This provider delivers 19× the peer median.Open Payments
Industry payments received
All-time total
$123
Transactions
1
Manufacturers
1
| Payer (manufacturer) | Industry | Txns | Amount |
|---|---|---|---|
| GlaxoSmithKline, LLC. | 1 | $123.15 |
By nature of payment
Medicare Part D · 2023
Top prescriptions
Total claims
350
Patients
193
Total drug cost
$4,794
| Drug | Type | Claims | Patients | Total cost |
|---|---|---|---|---|
| Azithromycin | Generic | 66 | 64 | $364 |
| Doxycycline Hyclate | Generic | 38 | 37 | $777 |
| Sulfamethoxazole-Trimethoprim (Sulfamethoxazole/Trimethoprim) | Brand | 31 | 28 | $174 |
| Omeprazole | Generic | 27 | 11 | $430 |
| Amlodipine Besylate | Generic | 26 | 15 | $325 |
| Metformin Hcl | Generic | 21 | 11 | $321 |
| Trazodone Hcl | Generic | 20 | 0 | $179 |
| Atorvastatin Calcium | Generic | 18 | 0 | $330 |
| Duloxetine Hcl | Generic | 17 | 0 | $161 |
| Diclofenac Sodium | Generic | 16 | 0 | $474 |
Frequently asked questions
What is Dr. Manivanh Prudhomme's medical specialty?
Dr. Manivanh Prudhomme practices Family Nurse Practitioner in Vicksburg, MS.
Where does Dr. Manivanh Prudhomme practice?
Dr. Manivanh Prudhomme practices at 2011 Highway 61 N, Vicksburg, MS 391833918. Office phone: 0145622776.
What is Dr. Manivanh Prudhomme's NPI?
Dr. Manivanh Prudhomme's National Provider Identifier (NPI) is 1144831140, issued by NPPES.
Does Dr. Manivanh Prudhomme accept Medicare assignment?
Yes. Dr. Manivanh Prudhomme accepts Medicare assignment, meaning Medicare-allowed amounts are accepted as full payment for covered services.
What procedures does Dr. Manivanh Prudhomme commonly perform?
Top Medicare-reported procedures in 2023: Injection, ceftriaxone sodium, per 250 mg (HCPCS J0696); Injection, dexamethasone sodium phosphate, 1 mg (HCPCS J1100); Established patient office or other outpatient visit (HCPCS 99214). Source: CMS Medicare Physician & Other Practitioners file.