NPIMap

Organization Active NPI

Maryville Pulmonary & Sleep Medicine, LLC

  • Pulmonary Disease Physician
  • Philadelphia, PA
National Provider Identifier
1053620765
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MD433403 Issued in PA
Legal business name
MARYVILLE PULMONARY & SLEEP MEDICINE, LLC
Practice address
5401 Old York Road
Klein-Suite 300
Philadelphia, PA 19141-3030
Phone
(215) 456-6950
Fax
(215) 456-1766
NPI assigned
Sep 29, 2010
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jaber M. Monla-Hassan, M.D.NPI 1871670943
Title
Owner
Phone
(865) 980-5100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 38341 TN
Pulmonary Disease Physician 207RP1001X MD433403 PA Primary
Sleep Medicine (Internal Medicine) Physician 207RS0012X 38341 TN

Addresses

Primary practice location

5401 Old York Road
Klein-Suite 300
Philadelphia, PA 19141-3030

Mailing address

PO Box 5659
Maryville, TN 37802-5659
Phone (865) 273-1752

Other practice location 1

365 Bmh Physicians Office Bldg
Maryville, TN 37804-5820
Phone (865) 980-5100

Other identifiers 1

IdentifierTypeStateIssuer
1520768MedicaidTN

National Provider Directory

National Provider Directory

Locations

365 Bmh Physicians Office Bldg
Maryville, TN 37804
Phone (865) 980-5100

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053620765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5659",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378025659",
            "telephone_number": "865-273-1752",
            "fax_number": "865-273-1755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 OLD YORK ROAD",
            "address_2": "KLEIN-SUITE 300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413030",
            "telephone_number": "215-456-6950",
            "fax_number": "215-456-1766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "365 Bmh Physicians Office Bldg",
            "address_purpose": "LOCATION",
            "city": "Maryville",
            "state": "TN",
            "postal_code": "378045820",
            "country_code": "US",
            "telephone_number": "865-980-5100",
            "fax_number": "865-980-5105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARYVILLE PULMONARY & SLEEP MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MONLA-HASSAN",
        "authorized_official_first_name": "JABER",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-980-5100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TN",
            "license": "38341",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "PA",
            "license": "MD433403",
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "TN",
            "license": "38341",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1520768",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.