Individual provider Active NPI

Molly M Mullaney, PA-C

  • Medical Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1336483015
Registry record updated Oct 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9106964 Issued in FL
Practice address
6555 Chester Ave Ste 1
Jacksonville, FL 32217-2279
Phone
(904) 265-8209
Fax
(904) 503-3577
NPI assigned
Nov 19, 2012
Last updated
Oct 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9106964 FL Primary

Addresses

Primary practice location

6555 Chester Ave Ste 1
Jacksonville, FL 32217-2279

Mailing address

2316 Indian Springs Dr
Jacksonville, FL 32246-4184
Phone (919) 302-9524

Other identifiers 2

IdentifierTypeStateIssuer
010438100MedicaidFL
PA9106964OtherFLMEDICAL LICENSE

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130411000306 FL Practitioner - Physician Assistant 6901042233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mori Bean and Brooks IncGroup PAC ID 8820077878, 966 clinicians

Practice addresses (Care Compare)

12807 River Story Way
Jacksonville, FL 32223-2403
Phone (904) 399-5550

1350 13TH Ave S
Jacksonville, FL 32250-3203
Phone (904) 399-5550

14550 Old Saint Augustine Rd
Jacksonville, FL 32258-2460
Phone (904) 399-5550

2001 Kingsley Ave
Orange Park, FL 32073-5148
Phone (904) 399-5550

2115 Little Rd
Trinity, FL 34655-4410
Phone (904) 399-5550

391 Spanish Creek Dr
Ponte Vedra, FL 32081-6175
Phone (904) 399-5550

800 Prudential Dr
Jacksonville, FL 32207-8202
Phone (904) 399-5550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.06 of 100Reported as group
Quality
72.79
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9106964FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
River City Nephrology PLLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26160/brand/1/csg/1/fhir/r4

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.

Hospital & facility affiliations 2

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": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759795200000",
    "number": "1336483015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2316 INDIAN SPRINGS DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322464184",
            "telephone_number": "919-302-9524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6555 CHESTER AVE STE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172279",
            "telephone_number": "904-265-8209",
            "fax_number": "904-503-3577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLANEY",
        "first_name": "MOLLY",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-19",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010438100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "PA9106964",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.