NPIMap

Individual provider Active NPI

Mary Mullen-Walsh, CRNP

  • Family Nurse Practitioner
  • Scranton, PA
National Provider Identifier
1104811140
Registry record updated Jan 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
VP005831B Issued in PA
Practice address
5 Morgan Hwy
Suite 4
Scranton, PA 18508-2641
Phone
(570) 344-3788
Fax
(570) 969-9280
NPI assigned
Sep 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X VP005831B PA Primary

Addresses

Primary practice location

5 Morgan Hwy
Suite 4
Scranton, PA 18508-2641

Mailing address

5 Morgan Hwy
Suite 4
Scranton, PA 18508-2641
Phone (570) 344-3788

Other identifiers 4

IdentifierTypeStateIssuer
103062761-0001MedicaidPA
P00293834OtherPARAILROAD MEDICARE
027924OtherPABLUE CARE
50076570OtherPACAPITAL BLUE CROSS

Other names 1

  • Mary Walsh Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20041102000932 PA Practitioner - Nurse Practitioner 6406818368 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1800 Mulberry St
Scranton, PA 18510-2369
Phone (570) 703-8000

5 Morgan Hwy
Suite 4
Scranton, PA 18508-2641
Phone (570) 344-3788

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
VP005831BPAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Rehabilitation Associates, PC CurrentSince Oct 4, 2004 Accepting new patients

Locations

5 Morgan Hwy
Ste 4
Scranton, PA 18508
Phone (570) 344-3788

1789 N Keyser Ave
Scranton, PA 18508
Phone (570) 969-1904

Interoperability endpoints

  • Direct secure messaging: mmullen-walsh@nerehab.medentdirect.com

Organizations & group practices 1

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 10

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": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1104811140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MORGAN HWY",
            "address_2": "SUITE 4",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185082641",
            "telephone_number": "570-344-3788",
            "fax_number": "570-969-9280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MORGAN HWY",
            "address_2": "SUITE 4",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185082641",
            "telephone_number": "570-344-3788",
            "fax_number": "570-969-9280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN-WALSH",
        "first_name": "MARY",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-15",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "VP005831B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103062761-0001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00293834",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE",
            "identifier": "027924",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50076570",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "WALSH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.