Individual provider Active NPI

Mairin Haley

  • Internal Medicine Physician
  • Broomall, PA
National Provider Identifier
1508444639
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD484483 Issued in PA
Practice address
1991 Sproul Rd Ste 140
Broomall, PA 19008-3512
Phone
(610) 625-0309
NPI assigned
Mar 30, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD484483 PA Primary

Addresses

Primary practice location

1991 Sproul Rd Ste 140
Broomall, PA 19008-3512

Mailing address

3803 W Chester Pike Ste 160
Newtown Square, PA 19073-2336
Phone (484) 337-1632

Other practice location 1

100 E Lancaster Ave
Wynnewood, PA 19096-3450
Phone (484) 476-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240513000244 PA Practitioner - Internal Medicine 0547661167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
George Washington University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians
Novacare Outpatient Rehabilitation East, Inc.Group PAC ID 3678480290, shared by 15 NPIs, 493 clinicians

Practice addresses (Care Compare)

1991 Sproul Rd
Broomall, PA 19008-3512
Phone (610) 325-1390

201 2ND Ave
Collegeville, PA 19426-3613
Phone (610) 489-7703

Hospital & facility affiliations

  • Main Line Health Home Care & Hospice - Home Health Home health agency, Radnor, PA, CCN 397012
  • Bayada Home Health Care, Inc. Home health agency, Newtown Square, PA, CCN 398267
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
  • Riddle Memorial Hospital Hospital, Media, PA, CCN 390222
  • Paoli Hospital Hospital, Paoli, PA, CCN 390153

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare Internal Medicine CurrentSince Jun 1, 2024 Accepting new patients

Locations

1991 Sproul Rd
Ste 140
Broomall, PA 19008
Phone (610) 325-0309

1991 Sproul Rd
Broomall, PA 19008
Phone (484) 476-3700

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

100 E Lancaster Ave
Wynnewood, PA 19096
Phone (484) 337-3583

100 E Lancaster Ave
#G10
Wynnewood, PA 19096
Phone (484) 476-2000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1508444639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3803 W CHESTER PIKE STE 160",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732336",
            "telephone_number": "484-337-1632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1991 SPROUL RD STE 140",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190083512",
            "telephone_number": "610-625-0309"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 E Lancaster Ave",
            "address_purpose": "LOCATION",
            "city": "Wynnewood",
            "state": "PA",
            "postal_code": "190963450",
            "country_code": "US",
            "telephone_number": "484-476-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALEY",
        "first_name": "MAIRIN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-30",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD484483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomall, PA

Sources for this page

Verify at the official NPI Registry.