Individual provider Active NPI

James P Mullen, MD

  • Nephrology Physician
  • Jupiter, FL
National Provider Identifier
1316918717
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME44545 Issued in FL
Practice address
4425 Military TRL
Suite 212
Jupiter, FL 33458-4819
Phone
(561) 721-1112
Fax
(561) 296-3082
NPI assigned
Feb 1, 2006
Last updated
Apr 17, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME44545 FL Primary

Addresses

Primary practice location

4425 Military TRL
Suite 212
Jupiter, FL 33458-4819

Mailing address

4425 Military TRL
Suite 212
Jupiter, FL 33458-4819
Phone (561) 721-1112

Other identifiers 1

IdentifierTypeStateIssuer
069303100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20100924001272 FL Practitioner - NephrologyPractitioner - Internal Medicine 2860492469 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME44545FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Kidney Care MD PA Nephrology CurrentSince Apr 2, 1999 Accepting new patients
Advanced Kidney Care MD PA Nephrology CurrentSince Apr 2, 1999 Accepting new patients

Locations

4425 Military Trl
Ste 212
Jupiter, FL 33458
Phone (561) 721-1112

1411 N Flagler Dr
Ste 8000
West Palm Beach, FL 33401
Phone (561) 650-6231

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1316918717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 MILITARY TRL",
            "address_2": "SUITE 212",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334584819",
            "telephone_number": "561-721-1112",
            "fax_number": "561-296-3082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 MILITARY TRL",
            "address_2": "SUITE 212",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334584819",
            "telephone_number": "561-721-1112",
            "fax_number": "561-296-3082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "JAMES",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME44545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069303100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jupiter, FL

Sources for this page

Verify at the official NPI Registry.