Individual provider Active NPI

Michael Edward Mullen, PA-C

  • Physician Assistant
  • Frederick, MD
National Provider Identifier
1417356825
Registry record updated Sep 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0005476 Issued in MD
Practice address
86 Thomas Johnson CT
Frederick, MD 21702-4348
Phone
(301) 694-8311
Fax
(301) 694-3537
NPI assigned
Aug 21, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2026

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 026100 NY
Physician Assistant 363A00000X MA056918 PA
Surgical Physician Assistant 363AS0400X OA003308 PA
Surgical Physician Assistant 363AS0400X MA056918 PA
Surgical Physician Assistant 363AS0400X 026100 NY
Physician Assistant 363A00000X C0005476 MD Primary

Addresses

Primary practice location

86 Thomas Johnson CT
Frederick, MD 21702-4348

Mailing address

86 Thomas Johnson CT
Frederick, MD 21702-4348
Phone (301) 694-8311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20220304000081 MD Practitioner - Physician Assistant 7214252162 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.93 of 100Reported as group
Quality
86.7
Promoting interoperability
100
Improvement activities
40
Cost
73.06

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C0005476MDMDPhysician Assistant
MA056918PAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centers for Advanced Orthopaedics, LLC Orthopaedic Surgery CurrentSince Feb 1, 2022 Accepting new patients
Centers for Advanced Orthopaedics, LLC Orthopaedic Surgery CurrentSince Feb 1, 2022 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
First State Orthopaedics, PA Orthopaedic Surgery Past Accepting new patients

Locations

86 Thomas Johnson Ct
Frederick, MD 21702
Phone (301) 607-0444

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788652800000",
    "number": "1417356825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 THOMAS JOHNSON CT",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024348",
            "telephone_number": "301-694-8311",
            "fax_number": "301-694-3537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 THOMAS JOHNSON CT",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024348",
            "telephone_number": "301-694-8311",
            "fax_number": "301-694-3537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "MICHAEL",
        "middle_name": "EDWARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-21",
        "last_updated": "2026-09-06",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "026100",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA056918",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "OA003308",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA056918",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "026100",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0005476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

Verify at the official NPI Registry.