NPIMap

Individual provider Active NPI

Michael Bryan Mullen, MD

  • Otolaryngology Physician
  • Mount Vernon, WA
National Provider Identifier
1174029078
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD61425983 Issued in WA
Practice address
118 S 12TH St
Mount Vernon, WA 98274-4036
Phone
(360) 336-2178
Fax
(360) 336-1995
NPI assigned
Apr 1, 2018
Last updated
Aug 23, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 1174029078 KY
Otolaryngology Physician 207Y00000X MD61425983 WA Primary

Addresses

Primary practice location

118 S 12TH St
Mount Vernon, WA 98274-4036

Mailing address

1400 E Kincaid St
Mount Vernon, WA 98274-4127

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmullen44797@skagit.direct-ci.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20230907002470 WA Practitioner - Otolaryngology 8123358090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians

Practice addresses (Care Compare)

118 S 12TH St
Mount Vernon, WA 98274-4036
Phone (360) 336-2178

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1174029078KYMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Aug 14, 2023 Accepting new patients
Public Hospital Dist No 1 Skagit Current Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Aug 14, 2023 Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients

Locations

1019 24th St
#B
Anacortes, WA 98221
Phone (360) 293-8438

118 S 12th St
Mount Vernon, WA 98274
Phone (360) 336-2178

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

Interoperability endpoints

  • Direct secure messaging: mmullen44797@skagit.direct-ci.com
  • Direct secure messaging: mmullen25073@ukhcdirect.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1522540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1174029078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 S 12TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744036",
            "telephone_number": "360-336-2178",
            "fax_number": "360-336-1995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "MICHAEL",
        "middle_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-01",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "KY",
            "license": "1174029078",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD61425983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmullen44797@skagit.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "Provider Direct Message",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "118 S 12th St",
            "city": "Mount Vernon",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982744036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.