Active NPI
Timothy James Mullally, DO
- Sports Medicine (Family Medicine) Physician
- Crown Point, IN
National Provider Identifier
1366462046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 02003099A
- Practice address
- 11275 Delaware Pkwy
Crown Point, IN 46307-7812 - Phone
- (219) 779-8735
- Fax
- (877) 715-2312
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 02003099A | IN | Primary |
| Family Medicine Physician | 207Q00000X | 02003099A | IN |
Addresses
Primary practice location
11275 Delaware Pkwy
Crown Point, IN 46307-7812
Mailing address
PO Box 108
Crown Point, IN 46308-0108
Phone (219) 779-8735
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200829740 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- 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
- Midwestern University, Chicago College of Osteopathic Med, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
11275 Delaware Pkwy
Suite a
Crown Point, IN 46307-7812
Phone (219) 779-8735
Hospital & facility affiliations
- Sunrise Home Health Care Services Inc
- Elara Caring
- Franciscan Home Care
- Franciscan Health Crown Point
- Community Hospital
- Powers Health Rehabilitation Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 15 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02003099A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana Sports & Medical Science Institute, PC | Family Medicine | Current | Accepting new patients |
Locations
11275 Delaware Pkwy
#A
Crown Point, IN 46307
Phone (219) 662-5530
11275 Delaware Pkwy
Crown Point, IN 46307
Phone (219) 779-8735
Interoperability endpoints
- tmullally@isamsip-in.direct.office.nextgen.com
- https://fhir.meditouchehr.com/api/fhir/r4/
Organizations & group practices 1
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.
-
- Clinic/Center
- Crown Point, IN
- NPI 1609155290
Family Medicine
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Rehabilitation Hospital
- Crown Point, IN
- NPI 1801301437
Inpatient rehabilitation facility
-
- General Acute Care Hospital
- Crown Point, IN
- NPI 1336205798
-
- Home Health Agency
- Hobart, IN
- NPI 1144225491
-
- Home Health Agency
- Valparaiso, IN
- NPI 1013493493
-
- General Acute Care Hospital
- Munster, IN
- NPI 1003918210
-
- Home Health Agency
- Merrillville, IN
- NPI 1093038853
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553472000000",
"number": "1366462046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 108",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463080108",
"telephone_number": "219-779-8735",
"fax_number": "877-715-2312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11275 DELAWARE PKWY",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463077812",
"telephone_number": "219-779-8735",
"fax_number": "877-715-2312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLALLY",
"first_name": "TIMOTHY",
"middle_name": "JAMES",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2019-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "IN",
"license": "02003099A",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "02003099A",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200829740",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crown Point, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; 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.