NPIMap

Individual provider Active NPI

Mariam Elizabeth Mansour, MD

  • Sports Medicine (Family Medicine) Physician
  • Germantown, TN
National Provider Identifier
1902434095
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
71949 Issued in TN
Practice address
1400 S Germantown Rd
Germantown, TN 38138-2205
Phone
(901) 759-3100
NPI assigned
Apr 1, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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
Sports Medicine (Family Medicine) Physician 207QS0010X 71949 TN Primary

Addresses

Primary practice location

1400 S Germantown Rd
Germantown, TN 38138-2205

Mailing address

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100

Other identifiers 1

IdentifierTypeStateIssuer
Q097465MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, TN2 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
I20240827004778 MS Practitioner - Family PracticePractitioner - Sports Medicine 4880133404 Reassigns benefits to 1 organization
I20241026000417 TN Practitioner - Family PracticePractitioner - Sports Medicine 4880133404 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Texas a & M University System, HSC, College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Campbell Clinic, PCGroup PAC ID 9638082076, 229 clinicians

Practice addresses (Care Compare)

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100

7545 Airways Blvd
Southaven, MS 38671-5806
Phone (901) 759-3196

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell Clinic, PC Sports Medicine CurrentSince Sep 1, 2024 Accepting new patients
Campbell Clinic PC CurrentSince Sep 1, 2024 Accepting new patients
Campbell Clinic Past Accepting new patients
CC Bpci PLC Past Accepting new patients

Locations

2608 S Lamar Blvd
#102
Oxford, MS 38655

7545 Airways Blvd
Southaven, MS 38671
Phone (901) 759-3196

1900 W Poplar Ave
Collierville, TN 38017
Phone (901) 759-5491

1400 S Germantown Rd
Memphis, TN 38138
Phone (901) 759-3111

7887 Wolf River Blvd
Memphis, TN 38138
Phone (901) 759-3180

1211 Union Ave
Ste 500
Memphis, TN 38104
Phone (901) 759-3275

8709 US Highway 51 N
Millington, TN 38053

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1366/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mariam.mansour.1@1366.direct.athenahealth.com

Organizations & group practices 4

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": "1585699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1902434095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S GERMANTOWN RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382205",
            "telephone_number": "901-759-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S GERMANTOWN RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382205",
            "telephone_number": "901-759-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "MARIAM",
        "middle_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-01",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TN",
            "license": "71949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q097465",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

Verify at the official NPI Registry.