NPIMap

Individual provider Active NPI

Abdul M Memon, MD

  • Pulmonary Disease Physician
  • Louisville, KY
National Provider Identifier
1720193642
Registry record updated Sep 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
40505 Issued in KY
Practice address
4402 Churchman Avenue
Suite 305
Louisville, KY 40215
Phone
(502) 368-9590
Fax
(502) 368-9616
NPI assigned
Aug 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X R8838 MO
Pulmonary Disease Physician 207RP1001X R8838 MO
Pulmonary Disease Physician 207RP1001X 40505 KY Primary

Addresses

Primary practice location

4402 Churchman Avenue
Suite 305
Louisville, KY 40215

Mailing address

4402 Churchman Avenue
Suite 305
Louisville, KY 40215
Phone (502) 368-9590

Other identifiers 3

IdentifierTypeStateIssuer
201413549MedicaidMO
000000511828OtherANTHEM
213320EOtherINMEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040701001015 MO Practitioner - Critical Care (Intensivists)Practitioner - Pulmonary Disease 8426035049 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Pulmonary Disease
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1229 E Seminole St
Springfield, MO 65804-2227
Phone (417) 888-5696

940 W Mount Vernon St
110 MC Imaging Services Nixa
Nixa, MO 65714-9613
Phone (417) 724-5450

Hospital & facility affiliations

  • Mercy Hospital Springfield Hospital, Springfield, MO, CCN 260065
  • Mercy Hospital Lebanon Hospital, Lebanon, MO, CCN 260059
  • Mercy Hospital Aurora Hospital, Aurora, MO, CCN 261316
  • Mercy St Francis Hospital Hospital, Mountain View, MO, CCN 261335

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R8838MOMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Joplin LLC CurrentSince Dec 1, 2014 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Aug 1, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Aug 1, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Aug 1, 2024 Accepting new patients
Midwest Pulmonary and Critical Care Consultants Inc Pulmonary Disease PastSince Aug 1, 2002 Accepting new patients
Sjmgroup Past Accepting new patients

Locations

94 Main St
Cassville, MO 65625
Phone (417) 782-7722

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

3126 S Jackson Ave
Joplin, MO 64804
Phone (417) 782-1600

940 W Mount Vernon St
Ste 110
Nixa, MO 65714
Phone (417) 724-5220

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

Interoperability endpoints

  • Direct secure messaging: abdul.memon.1@18822.direct.athenahealth.com

Organizations & group practices 6

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410134400000",
    "number": "1720193642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 CHURCHMAN AVENUE",
            "address_2": "SUITE 305",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-368-9590",
            "fax_number": "502-368-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 CHURCHMAN AVENUE",
            "address_2": "SUITE 305",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-368-9590",
            "fax_number": "502-368-9616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMON",
        "first_name": "ABDUL",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2014-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MO",
            "license": "R8838",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MO",
            "license": "R8838",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "KY",
            "license": "40505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201413549",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000511828",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "213320E",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.