Thomas S Mullally, MD
Individual provider Active NPI Family Medicine Physician · Croswell, MI
NPI 1629030879 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1629030879
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- TM051015 (MI)
- Practice address
- 5525 E Peck Rd
Croswell, MI 48422 - Phone
- (810) 679-2950
- Fax
- (810) 679-2960
- NPI assigned
- Apr 4, 2006
- Sex
- Male
- Sole proprietor
- No
Hospital & facility affiliations 10
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Wayne State University School of Medicine, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5525 Peck Rd
Croswell, MI 48422-9108
Phone (810) 679-2950
Hospital & facility affiliations
- Residential Home Health and Hospice
- Vna Home Health Care
- Lake Huron Medical Center
- McKenzie Health System
- McLaren Port Huron
- Deckerville Community Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120130000092 | MI | Practitioner - Family Practice | 0446417778 | Practice locations: Croswell, MI |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TM051015 | MI | MD | Family Medicine Physician |
Interoperability endpoints
- thomasmullallymd@croslexfamilymedicine.amazing-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | TM051015 | MI | Yes |
Addresses
Primary practice location
5525 E Peck Rd
Croswell, MI 48422
Mailing address
5525 E Peck Rd
Croswell, MI 48422
Phone (810) 679-2950
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2695679 | Medicaid | MI | |
| 0760069 | Other | BCBSM |
Other providers in Croswell, MI
- Brian Linne
- Benjamin Martin Sr.
- Karmen Jo McMillan
- Sherri Metevier
- Loretta A Mullally
- Syvanna Lee Nantroup
- Ashley Marie Nelson
- Madison Ottenbacher
- Kellie Lynn Parkinson
- Jamie Parrent
All providers in Croswell, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.