NPIMap

Individual provider Active NPI

Elie Mansour, M.D.

  • Pulmonary Disease Physician
  • La Follette, TN
National Provider Identifier
1942246145
Registry record updated Nov 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MD21870 Issued in TN
Practice address
919 E Central Ave
Suite 103
La Follette, TN 37766-2777
Phone
(423) 562-4976
Fax
(423) 566-5896
NPI assigned
Jun 22, 2006
Last updated
Nov 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X MD21870 TN Primary

Addresses

Primary practice location

919 E Central Ave
Suite 103
La Follette, TN 37766-2777

Mailing address

919 E Central Ave
Suite 103
La Follette, TN 37766-2777
Phone (423) 562-4976

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20040415000406 TN Practitioner - Internal Medicine 5799770293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

919 E Central Ave
Suite 103
La Follette, TN 37766-2778
Phone (423) 562-4976

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.45 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
74.84

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD21870TNMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Elie Mansour, MD, PC Pulmonary Disease CurrentSince Mar 8, 2005 Accepting new patients
Campbell County Hma LLC Past Accepting new patients
Campbell County Hma, LLC Past Accepting new patients
Campbell County Hma, LLC Past Accepting new patients
Sunbridge Regency - Tennessee LLC Past Accepting new patients

Locations

919 East Ave
Ste 103
La Follette, TN 37766
Phone (423) 562-4970

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Cumberland Village CareLa Follette, TN, CCN 445276 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2020
Jan 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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

Hospital & facility affiliations 6

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194566400000",
    "number": "1942246145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 E CENTRAL AVE",
            "address_2": "SUITE 103",
            "city": "LA FOLLETTE",
            "state": "TN",
            "postal_code": "377662777",
            "telephone_number": "423-562-4976",
            "fax_number": "423-566-5896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 E CENTRAL AVE",
            "address_2": "SUITE 103",
            "city": "LA FOLLETTE",
            "state": "TN",
            "postal_code": "377662777",
            "telephone_number": "423-562-4976",
            "fax_number": "423-566-5896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "ELIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TN",
            "license": "MD21870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Follette, TN

Sources for this page

Verify at the official NPI Registry.