Suparna Mullick, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

49897 Issued in TN

Practice address

3036 Centre Oak Way
Germantown, TN 38138-6302

Phone

(901) 572-0005

Fax

(901) 572-1102

NPI assigned

Sep 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Dermatology

Education

Other, 2002

Medicare assignment

May accept Medicare assignment

Group practices

Mullick Dermatology PLLCGroup PAC ID 3870862386, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: smullick33207@mlh.direct-ci.com

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.

• Mullick Dermatology, PLLC

  • Dermatology Physician
  • Germantown, TN
  • NPI 1154862217

  Dermatology, TN

  Medicare reassignment Care Compare group NPD Authorized official
• Dr. Adam T Keres LLC.

  • Chiropractor
  • Memphis, TN
  • NPI 1376738351
  NPD (past)
• Wright Dermatology, PLLC

  • Dermatology Physician
  • Jackson, TN
  • NPI 1245740547

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1366547713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 758",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382420758",
            "telephone_number": "901-572-0005",
            "fax_number": "901-572-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3036 CENTRE OAK WAY",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381386302",
            "telephone_number": "901-572-0005",
            "fax_number": "901-572-1102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9760 Lipsey Cv",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "TN",
            "postal_code": "381398076",
            "country_code": "US",
            "telephone_number": "901-277-3534",
            "fax_number": "901-757-9065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULLICK",
        "first_name": "SUPARNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2006013531",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TN",
            "license": "49897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200382901",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert J. Moskop, M.D.
• MSK Group, PC
• Lyle E. Muller, DDS
• Richard Grant Muller
• Mullick Dermatology, PLLC
• Shelley N Mulrooney, PA-C
• Catherine Mulroy Munn, M.D.
• Teresa Murphree, FNP-BC
• Austin Brandon Murphy, M.D.
• Garnett Andrew Murphy, M.D.

• All providers in Germantown, TN
• Dermatology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; 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.

Verify at the official NPI Registry.