NPIMap

Individual provider Active NPI

Maryam Hanoodi, MD

  • Internal Medicine Physician
  • Chula Vista, CA
National Provider Identifier
1760061212
Registry record updated Feb 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C200635 Issued in CA
Practice address
480 H Street
Chula Vista, CA 91910
Phone
(858) 499-2600
NPI assigned
Apr 2, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X C200635 CA Primary
Hospitalist Physician 208M00000X MD485350 PA

Addresses

Primary practice location

480 H Street
Chula Vista, CA 91910

Mailing address

480 H Street
Chula Vista, CA 91910
Phone (858) 499-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240914000219 PA Practitioner - Internal Medicine 6103366380 Reassigns benefits to 1 organization
I20260127000888 CA Practitioner - Internal Medicine 6103366380 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians
Sharp Rees-Stealy Medical Group IncGroup PAC ID 8628972759, 872 clinicians

Practice addresses (Care Compare)

1000 E Mountain Dr
Wilkes Barre, PA 18711-0001
Phone (570) 826-7850

10670 Wexford St
San Diego, CA 92131-3940
Phone (858) 621-4002

480 H St
Chula Vista, CA 91910-4328
Phone (858) 499-2600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C200635CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Sep 3, 2024 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Internal Medicine CurrentSince Dec 15, 2025 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Dec 15, 2025 Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients
Geisinger Wyoming Valley Medical Center Past Accepting new patients

Locations

480 H St
Chula Vista, CA 91910
Phone (619) 420-7120

525 Third Ave
Chula Vista, CA 91910
Phone (619) 585-4050

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

100 N Academy Ave
Danville, PA 17822

1000 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 826-7300

1000 E Mountain Blvd
Wilkes Barre, PA 18711
Phone (570) 808-7399

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1617321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771372800000",
    "number": "1760061212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 H STREET",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "858-499-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 H STREET",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "858-499-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANOODI",
        "first_name": "MARYAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-02",
        "last_updated": "2026-02-18",
        "certification_date": "2026-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C200635",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "MD485350",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.