Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1427042159 Deactivated / Inactive NPI Male Practitioner

Dr. Ronald Edward Manicom , MD

Specialist • Austin, TX

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Ronald Manicom has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 08, 2005
NPI Deactivation Date March 25, 2006
Total Practice Duration ~1 Years of Practice (2005 – 2006)

Professional Overview & Biography Verified Profile Summary

Dr. Ronald Manicom, MD was a registered Specialist practicing in Austin, TX. Throughout an active medical career spanning 1 years, Dr. Manicom provided care at the practice location at 711 W 38TH ST until profile deactivation on 2006-03-25.

Practice Location & Contact Primary Location

Practice Address

711 W 38th St
D-4

Austin, TX 787051121

Telephone 5124549627
Fax 5124546310
Associated Practice Facility / Clinic
🏢 Austin Open Mri Lp Facility NPI 1992780902

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Austin, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 36.1 Yrs
State Avg: 38.0 Yrs
Regional Practice Density
86 Specialists

Practicing in Austin, TX (2033 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License TX C9055

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
180051801 (TX)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Edwin Buster , MD

Neurological Surgery

NPI 1366550808

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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Updated Practice Location January 20, 2010

Registered at 711 W 38TH ST, D-4, AUSTIN, TX 787051121 (Tel: 5124549627)

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Updated Business Mailing Address January 20, 2010

Registered at 711 W 38TH ST, D-4, AUSTIN, TX 787051121 (Tel: 5124549627)

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Provider Name / Credentials Updated January 20, 2010

Recorded as RONALD MANICOM, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) January 20, 2010

Specialist (License #C9055 in TX)

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NPI Profile Reactivated March 31, 2006

Record officially reactivated for active practice on March 31, 2006

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NPI Profile Deactivated March 25, 2006

Record deactivated on March 25, 2006

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Initial NPI Registration & Enumeration September 08, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1427042159
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 08, 2005
Last Update: January 20, 2010
Deactivation Date: March 25, 2006
Sole Proprietor: No

Mailing Address

711 W 38th St, D-4

Austin, TX 787051121

Phone: 5124549627

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.