Mridul K Mazumder, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME129519 Issued in FL

Practice address

1616 Physicians Dr
Tallahassee, FL 32308-4619

Phone

(850) 431-5119

Fax

(850) 431-2467

NPI assigned

Jan 25, 2007

Last updated

Feb 26, 2021By the provider in NPPES

Sex

Male

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 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

Specialty

Psychiatry

Education

University of Arkansas College of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Medical Practice Plan IncGroup PAC ID 3971608993, 27 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

87.33 of 100Reported as group

Quality

89.31

Promoting interoperability

100

Improvement activities

40

Cost

68.47

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mridual.mazumder.1@19268.direct.athenahealth.com

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.

• Florida Medical Practice Plan Inc

  • General Practice Physician
  • Tallahassee, FL
  • NPI 1326386293
  Medicare reassignment Care Compare group NPD
• Florida First Psychiatry Specialist LLC

  • Geriatric Psychiatry Physician
  • Tallahassee, FL
  • NPI 1841754959
  NPD (past)
• South Carolina Dept of Mental Health Accounting Office

  dba Santee-Wateree Community Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sumter, SC
  • NPI 1245279595
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1407902364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 W CALL ST",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323043556",
            "telephone_number": "850-431-5119",
            "fax_number": "850-431-2467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 PHYSICIANS DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084619",
            "telephone_number": "850-431-5119",
            "fax_number": "850-431-2467"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4449 Meandering Way",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323085740",
            "country_code": "US",
            "telephone_number": "850-644-1543 x1",
            "fax_number": "855-230-7402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAZUMDER",
        "first_name": "MRIDUL",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME129519",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "27255",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272555",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Mayol, MD
• Sophya Waleska Mayora
• Erica L Mays, PHARMD
• Etienne Mazimpaka
• Christina Mazone
• David Timothy Mazur, D.M.D.
• Gabriella Nicole Mazur
• Landon Cameron Mazyck, D.M.D.
• Jessica Mazzariello
• Alexandria Mazzei, RN

• Psychiatry Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; 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.