NPIMap

Organization Active NPI

Southeast Lung & Critical Care Specialists

  • Pulmonary Disease Physician
  • Sylvania, GA
National Provider Identifier
1689998536
Registry record updated Mar 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
052469 Issued in GA
Legal business name
SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS
Practice address
209C Mims Rd
Sylvania, GA 30467-1994
Phone
(912) 564-5977
Fax
(912) 564-1259
NPI assigned
Mar 22, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2010

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

Authorized official

Name
Maria Mascolo III, M.D.
Title
Partner
Phone
(912) 354-6614

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X 052469 GA Primary

Addresses

Primary practice location

209C Mims Rd
Sylvania, GA 30467-1994

Mailing address

340 Eisenhower Dr
Building #1500
Savannah, GA 31406-1600
Phone (912) 354-6614

Other identifiers 1

IdentifierTypeStateIssuer
487007710AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000176 GA Part B Supplier - Clinic/Group Practice 7618962291 Receives reassigned benefits from 29 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jesup, GA; Vidalia, GA; Tybee Island, GA; Sylvania, GA; Springfield, GA; Savannah, GA; Hinesville, GA; Brunswick, GA…

Other NPIs on the same Medicare enrollment 33

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 33

National Provider Directory

National Provider Directory
Tax ID family
Southeast Lung Associates40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1269216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269216000000",
    "number": "1689998536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 EISENHOWER DR",
            "address_2": "BUILDING #1500",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314061600",
            "telephone_number": "912-354-6614",
            "fax_number": "912-356-9078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209C MIMS RD",
            "city": "SYLVANIA",
            "state": "GA",
            "postal_code": "304671994",
            "telephone_number": "912-564-5977",
            "fax_number": "912-564-1259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-22",
        "last_updated": "2010-03-22",
        "status": "A",
        "authorized_official_last_name": "MASCOLO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "912-354-6614",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "GA",
            "license": "052469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "487007710A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylvania, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.