NPIMap

Individual provider Active NPI

John Patrick Mullally, MD

  • Family Medicine Physician
  • Port Huron, MI
National Provider Identifier
1033105630
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301059921 Issued in MI
Practice address
1117 Stone St
Suite 2
Port Huron, MI 48060
Phone
(810) 966-4540
Fax
(810) 966-4549
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301059921 MI Primary

Addresses

Primary practice location

1117 Stone St
Suite 2
Port Huron, MI 48060

Mailing address

1117 Stone St
Suite 2
Port Huron, MI 48060
Phone (810) 966-4540

Other identifiers 4

IdentifierTypeStateIssuer
0740124OtherMIBCBS
104299OtherMICARE CHOICES
G13412OtherMIHAP
4352066MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20101013000748 MI Practitioner - Family Practice 7618169384 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1117 Stone St
Suite 2
Port Huron, MI 48060-3525
Phone (810) 966-4540

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301059921MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
J Mullally MD PLLC Family Medicine CurrentSince Jun 23, 2010 Accepting new patients
Prime Healthcare Services-Port Huron LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
McLaren Port Huron Past Accepting new patients

Locations

1117 Stone St
Ste 2
Port Huron, MI 48060
Phone (810) 966-4540

Interoperability endpoints

  • Direct secure messaging: drmullally@johnmullally.directbygreenway.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 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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1033105630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 STONE ST",
            "address_2": "SUITE 2",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "48060",
            "telephone_number": "810-966-4540",
            "fax_number": "810-966-4549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 STONE ST",
            "address_2": "SUITE 2",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "48060",
            "telephone_number": "810-966-4540",
            "fax_number": "810-966-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLALLY",
        "first_name": "JOHN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301059921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0740124",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "104299",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "G13412",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4352066",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.