Individual provider Active NPI

Thomas J Mulvey, MD

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Peoria, IL
National Provider Identifier
1174519219
Registry record updated Dec 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
036094833 Issued in IL
Practice address
6000 N Allen Road
Peoria, IL 61614-3294
Phone
(309) 691-1400
NPI assigned
Sep 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 036094833 IL Primary
Specialist 174400000X 036094833 IL

Addresses

Primary practice location

6000 N Allen Road
Peoria, IL 61614-3294

Mailing address

6000 N Allen Road
Peoria, IL 61614-3294
Phone (309) 691-1400

Other identifiers 1

IdentifierTypeStateIssuer
036094833MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20100319000360 IL Practitioner - Orthopedic Surgery 7719886084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Creighton University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Physical Therapy Services, LTD.Group PAC ID 9133101462, shared by 5 NPIs, 216 clinicians
Midwest Orthopaedic Center S CGroup PAC ID 8022917715, 45 clinicians

Practice addresses (Care Compare)

300 Tenney St
Kewanee, IL 61443-3452
Phone (309) 853-5500

6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400

61 E Side SQ
Canton, IL 61520-2603
Phone (309) 649-1572

Hospital & facility affiliations

  • Carle Health Proctor Hospital Hospital, Peoria, IL, CCN 140013
  • Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209
  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
  • Carle Health Pekin Hospital Hospital, Pekin, IL, CCN 140120
  • St Mary Medical Center Hospital, Galesburg, IL, CCN 140064

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement37
Knee replacement108

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036094833ILMDAdult Reconstructive Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Orthopaedic Center S C Specialist CurrentSince Oct 1, 1999 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

6000 N Allen Rd
Peoria, IL 61614
Phone (309) 391-1400

Organizations & group practices 2

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 5

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733616000000",
    "number": "1174519219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN ROAD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "309-691-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 N ALLEN ROAD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143294",
            "telephone_number": "309-691-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULVEY",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2024-12-08",
        "certification_date": "2024-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "IL",
            "license": "036094833",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036094833",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036094833",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.