Andrew J Mullally, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01074259A Issued in IN

Practice address

10050 Auburn Park Dr
Fort Wayne, IN 46825-2389

Phone

(260) 432-6459

Fax

(260) 240-5284

NPI assigned

Jun 13, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: Emergency Medicine

Education

Michigan State University College of Human Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Credo Health Group LLCGroup PAC ID 2769775782, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
• Dupont Hospital LLC Hospital, Fort Wayne, IN, CCN 150150
• Lutheran Hospital of Indiana Hospital, Fort Wayne, IN, CCN 150017
• Parkview Dekalb Hospital Hospital, Auburn, IN, CCN 150045

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: andrewmullally@credofamilymedicine.amazing-direct.com

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.

• Credo Health Group, LLC

  dba Credo Family Medicine

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1407203672
  Medicare reassignment Care Compare group NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dekalb Memorial Hospital, Inc

  dba Parkview Dekalb Hospital

  • General Acute Care Hospital
  • Auburn, IN
  • NPI 1902897937
  Care Compare affiliation
• Dupont Hospital LLC

  dba Dupont Hospital

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1538110556
  Care Compare affiliation
• Iom Health System LP

  dba Lutheran Hospital of Indiana

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1306897335
  Care Compare affiliation
• Parkview Hospital, Inc.

  dba Parkview Regional Medical Center

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation

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

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492646400000",
    "number": "1164860086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10050 AUBURN PARK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252389",
            "telephone_number": "260-432-6459",
            "fax_number": "260-240-5284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10050 AUBURN PARK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252389",
            "telephone_number": "260-432-6459",
            "fax_number": "260-240-5284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLALLY",
        "first_name": "ANDREW",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-13",
        "last_updated": "2017-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01074259A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sikira Mukaila
• Sidra Mukhtar, MD
• Lorraine Mukona, MD
• Bronson Mulder, RBT
• Genelle Mull, PTA
• Joseph C Muller, M.D.
• Marzena Wiacek Muller, M.D.
• Robert FB Muller, M.D.
• Amanda Mullins, LPN
• Lauren M Mullins, RD

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.