NPIMap

Individual provider Active NPI

Michael Mull, MD

  • Family Medicine Physician
  • Peru, IN
National Provider Identifier
1134206014
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01040504 Issued in IN
Practice address
315 W Old Key Dr
Peru, IN 46970-9057
Phone
(765) 475-6963
Fax
(765) 475-2833
NPI assigned
Oct 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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 01040504 IN Primary

Addresses

Primary practice location

315 W Old Key Dr
Peru, IN 46970-9057

Mailing address

315 W Old Key Dr
Peru, IN 46970-9057
Phone (765) 475-6963

Other identifiers 1

IdentifierTypeStateIssuer
100432790MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address michael.mullmd.p11@direct.ahni.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20040429001011 IN Practitioner - Family Practice 1456348556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10995 Allisonville Rd
Suite 100
Fishers, IN 46038-2616
Phone (317) 842-7928

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01040504INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Health Network of Indiana LLC CurrentSince Aug 1, 2000 Accepting new patients
American Health Network of Indiana, LLC Family Medicine CurrentSince Aug 1, 2000 Accepting new patients
American Health Network of Indiana, LLC Family Medicine Past Accepting new patients

Locations

10995 Allisonville Rd
Ste 100
Fishers, IN 46038
Phone (317) 842-7928

7440 Woodland Dr
Indianapolis, IN 46278
Phone (317) 450-3357

2330 S Dixon Rd
Kokomo, IN 46902
Phone (765) 455-5400

1445 W Hoosier Blvd
Peru, IN 46970
Phone (765) 689-0071

Interoperability endpoints

  • Direct secure messaging: michael.mullmd.p11@direct.ahni.nextgenshare.com
  • Direct secure messaging: mmull211051@direct.optum.com

Organizations & group practices 3

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 8

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": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1134206014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W OLD KEY DR",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469709057",
            "telephone_number": "765-475-6963",
            "fax_number": "765-475-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W OLD KEY DR",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469709057",
            "telephone_number": "765-475-6963",
            "fax_number": "765-475-2833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULL",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01040504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100432790",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.mullmd.p11@direct.ahni.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "315 W Old Key Dr",
            "city": "Peru",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469709057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Peru, IN

Sources for this page

Verify at the official NPI Registry.