NPIMap

Organization Active NPI

Mill City Medical Group LTD

  • Internal Medicine Physician
  • Lowell, MA
National Provider Identifier
1053346692
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MILL CITY MEDICAL GROUP LTD
Practice address
45 Palmer Street
Lowell, MA 01852
Phone
(978) 970-1607
Fax
(978) 970-1115
NPI assigned
Jul 12, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
David C Pickul, MD
Title
President
Phone
(978) 970-1607

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

45 Palmer Street
Lowell, MA 01852

Mailing address

45 Palmer Street
Lowell, MA 01852
Phone (978) 970-1607

Other identifiers 1

IdentifierTypeStateIssuer
9719628MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050617000355 MA Part B Supplier - Clinic/Group Practice 3577507797 Receives reassigned benefits from 20 practitioners
Practice locations: Dracut, MA; Lowell, MA

National Provider Directory

National Provider Directory

Locations

1175 Mammoth Rd
Ste 1
Dracut, MA 01826
Phone (978) 955-9500

295 Varnum Ave
Lowell, MA 01854
Phone (978) 788-7344

45 Palmer St
Lowell, MA 01852
Phone (978) 452-5807

595 Pawtucket Blvd
Ste 2
Lowell, MA 01854
Phone (978) 459-8447

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053346692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 PALMER STREET",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "01852",
            "telephone_number": "978-970-1607",
            "fax_number": "978-970-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 PALMER STREET",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "01852",
            "telephone_number": "978-970-1607",
            "fax_number": "978-970-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL CITY MEDICAL GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PICKUL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-970-1607",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9719628",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lowell, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.