Individual provider Active NPI

Michelle P Mulligan, M.D.

  • Family Medicine Physician
  • Edwardsville, IL
National Provider Identifier
1194721936
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036081019 Issued in IL
Practice address
3417 Anderson Healthcare Dr Ste 200
Edwardsville, IL 62025-7784
Phone
(618) 288-8500
Fax
(618) 288-8501
NPI assigned
Jun 27, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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 036081019 IL Primary

Addresses

Primary practice location

3417 Anderson Healthcare Dr Ste 200
Edwardsville, IL 62025-7784

Mailing address

6810 State Route 162
Box 215
Maryville, IL 62062
Phone (618) 391-6495

Other identifiers 6

IdentifierTypeStateIssuer
0107339OtherUNITED HEALTHCARE
080021120OtherILRR MEDICARE
N8565OtherGROUP HEALTH PLAN
4622029OtherILADMINISTAR
036081019MedicaidIL
180420OtherHEALTHLINK

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
I20100217000583 IL Practitioner - Family Practice 2961546775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Kansas City, School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

3403 Anderson Healthcare Dr
Edwardsville, IL 62025-7784
Phone (618) 288-8350

3417 Anderson Healthcare Dr
Suite 200
Edwardsville, IL 62025-7784
Phone (618) 288-8500

Hospital & facility affiliations

  • Anderson Hospital Hospital, Maryville, IL, CCN 140289
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Memorial Hospital Hospital, Belleville, IL, CCN 140185
  • Community Hospital of Staunton Hospital, Staunton, IL, CCN 141306

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC Family Medicine CurrentSince Jan 1, 2018 Accepting new patients
Central Illinois Radiological Associates, LTD. PastSince Sep 1, 2024 Accepting new patients

Locations

3417 Anderson Healthcare Dr
Ste 200
Edwardsville, IL 62025
Phone (618) 288-8500

3 Junction Dr W
Glen Carbon, IL 62034
Phone (618) 288-5088

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

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 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": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1194721936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162",
            "address_2": "BOX 215",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "62062",
            "telephone_number": "618-391-6495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 ANDERSON HEALTHCARE DR STE 200",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620257784",
            "telephone_number": "618-288-8500",
            "fax_number": "618-288-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLIGAN",
        "first_name": "MICHELLE",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-27",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036081019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0107339",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080021120",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PLAN",
            "identifier": "N8565",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINISTAR",
            "identifier": "4622029",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036081019",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "180420",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

Verify at the official NPI Registry.