NPIMap

Individual provider Active NPI

Jeffrey Mullen, MD

  • Emergency Medicine Physician
  • Charleston, WV
National Provider Identifier
1164537304
Registry record updated Jan 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2010 Issued in WV
Practice address
3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Phone
(304) 388-4170
NPI assigned
Aug 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2010 WV Primary

Addresses

Primary practice location

3200 Maccorkle Ave SE
Charleston, WV 25304-1227

Mailing address

3100 Maccorkle Ave SE
Ste 203
Charleston, WV 25304-1228
Phone (304) 388-1724

Other identifiers 3

IdentifierTypeStateIssuer
1068868OtherWVWV DWC
001884657OtherWVWV BCBS
3810006147MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20041023000209 WV Practitioner - Emergency Medicine 9436110301 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Area Medical Center IncGroup PAC ID 3375441637, 969 clinicians

Practice addresses (Care Compare)

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Greenbrier Emergency Services, Inc. Emergency Medicine CurrentSince Jan 18, 2015 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Jan 1, 2017 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Jan 1, 2017 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients
Emergency Medicine Physicians of Kanawha County, PLLC Emergency Medicine Past Accepting new patients

Locations

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

3100 Maccorkle Ave SE
Ste 203
Charleston, WV 25304
Phone (304) 345-8820

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

800 Pennsylvania Ave
Charleston, WV 25302
Phone (304) 388-2550

4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800

601 Colliers Way
Weirton, WV 26062
Phone (304) 364-5156

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 and National Provider Directory roles.

Hospital & facility affiliations 11

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483401600000",
    "number": "1164537304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE",
            "address_2": "STE 203",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041228",
            "telephone_number": "304-388-1724",
            "fax_number": "304-388-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041227",
            "telephone_number": "304-388-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "JEFFREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2017-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "2010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV DWC",
            "identifier": "1068868",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV BCBS",
            "identifier": "001884657",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006147",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.