Individual provider Active NPI

William J. Mullally, MD

  • Neurology Physician
  • Braintree, MA
National Provider Identifier
1659463339
Registry record updated Jun 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
46261 Issued in MA
Practice address
111 Grossman Dr
Neurology
Braintree, MA 02184-4997
Phone
(781) 849-2265
Fax
(781) 849-2274
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 46261 MA
Neurology Physician 2084N0400X 46261 MA Primary

Addresses

Primary practice location

111 Grossman Dr
Neurology
Braintree, MA 02184-4997

Mailing address

147 Milk St
Provider Enrollment 9TH Floor
Boston, MA 02109-4806
Phone (617) 421-6540

Other identifiers 7

IdentifierTypeStateIssuer
111404OtherMAHARVARD PILGRIM
0014880OtherMANEIGHBORHOOD HEALTH PLAN
3179591MedicaidMA
046261OtherMATUFTS HEALTH PLAN
P00086706OtherMAMEDICARE RAILROAD
J12153OtherMABLUE CROSS
7011385-002OtherMACIGNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20050425000098 MA Practitioner - NeurologyPractitioner - Internal Medicine 1355389859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Internal Medicine
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham and Women's Faulkner Hospital, Inc Current Accepting new patients
Brigham and Womens Physicians Organization Inc Past Accepting new patients
Atrius Health, Inc. Internal Medicine Past Accepting new patients

Locations

75 Francis St
Boston, MA 02115

1153 Centre St
Jamaica Plain, MA 02130
Phone (617) 983-7000

1153 Centre St
#L1
Jamaica Plain, MA 02130

Interoperability endpoints

  • Direct secure messaging: wmullally188678@direct.ochin.org
  • Direct secure messaging: mullally.william.bwh@direct.partners.masshiway.net

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307404800000",
    "number": "1659463339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 MILK ST",
            "address_2": "PROVIDER ENROLLMENT 9TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021094806",
            "telephone_number": "617-421-6540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GROSSMAN DR",
            "address_2": "NEUROLOGY",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "021844997",
            "telephone_number": "781-849-2265",
            "fax_number": "781-849-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLALLY",
        "first_name": "WILLIAM",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2011-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "46261",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MA",
            "license": "46261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "111404",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "0014880",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3179591",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "046261",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00086706",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "J12153",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7011385-002",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Braintree, MA

Sources for this page

Verify at the official NPI Registry.