Active NPI
Michelle P Mulligan, M.D.
- Family Medicine Physician
- Edwardsville, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036081019
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0107339 | Other | UNITED HEALTHCARE | |
| 080021120 | Other | IL | RR MEDICARE |
| N8565 | Other | GROUP HEALTH PLAN | |
| 4622029 | Other | IL | ADMINISTAR |
| 036081019 | Medicaid | IL | |
| 180420 | Other | HEALTHLINK |
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
Enrollment records 1
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
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
- Barnes Jewish Hospital
- Memorial Hospital
- Community Hospital of Staunton
Merit-based Incentive Payment System (MIPS)
- Final score
- 74.76 of 100
- Quality
- 54.98
- Promoting interoperability
- 85
- Improvement activities
- 40
- Cost
- 73.39
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anderson Medical Group, LLC | Family Medicine | Current | Accepting new patients |
| Central Illinois Radiological Associates, LTD. | Past | 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.
-
- Diagnostic Radiology Physician
- Peoria, IL
- NPI 1538192828
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Maryville, IL
- NPI 1053481630
-
- Critical Access Hospital
- Staunton, IL
- NPI 1750308631
-
- General Acute Care Hospital
- Belleville, IL
- NPI 1982796181
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1649299827
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.