Individual provider Active NPI

Peter J Mulhern, MD

  • Orthopaedic Surgery Physician
  • Lady Lake, FL
National Provider Identifier
1417932005
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
053517 Issued in GA
Practice address
8550 NE 138TH LN
Building 400, Suite 101B
Lady Lake, FL 32159-8957
Phone
(352) 751-1036
Fax
(352) 750-4698
NPI assigned
Dec 7, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 053517 GA Primary

Addresses

Primary practice location

8550 NE 138TH LN
Building 400, Suite 101B
Lady Lake, FL 32159-8957

Mailing address

PO Box 3130
Ocala, FL 34478-3130
Phone (352) 751-1036

Other identifiers 1

IdentifierTypeStateIssuer
06698867AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120222001064 FL Practitioner - Orthopedic Surgery 6800843640 Reassigns benefits to 1 organization
I20180313000836 IL Practitioner - Orthopedic Surgery 6800843640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
77.51 of 100Reported as group
Quality
49.04
Promoting interoperability
95
Improvement activities
40
Cost
69.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
37362TNMDPharmacist
053517GAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Specialty Clinic, Inc. Orthopaedic Surgery CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. CurrentSince Jan 14, 2023 Accepting new patients
Omni Healthcare, Inc. CurrentSince Sep 1, 2020 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. Current Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients
Parkway Orthopaedic Center, PC Orthopaedic Surgery PastSince Nov 1, 2006 Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients

Locations

1344 S Apollo Blvd
Ste 406
Melbourne, FL 32901
Phone (321) 253-4032

205 Bailey Ln
Benton, IL 62812
Phone (618) 435-8189

303 S Commercial St
Harrisburg, IL 62946
Phone (618) 767-6050

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

4113 S Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 241-9071

209 Crossroads Pl
Ste 150
Mount Vernon, IL 62864
Phone (618) 244-6222

509 Hamacher St
Waterloo, IL 62298
Phone (618) 939-3939

Interoperability endpoints

  • Direct secure messaging: peter.mulhern.1@27782.direct.athenahealth.com

Organizations & group practices 7

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": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1417932005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3130",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344783130",
            "telephone_number": "352-751-1036",
            "fax_number": "352-750-4698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8550 NE 138TH LN",
            "address_2": "BUILDING 400, SUITE 101B",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321598957",
            "telephone_number": "352-751-1036",
            "fax_number": "352-750-4698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULHERN",
        "first_name": "PETER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "053517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06698867A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

Verify at the official NPI Registry.