Individual provider Active NPI

John F Mullaney, MD

  • Internal Medicine Physician
  • Wakefield, RI
National Provider Identifier
1669484929
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD16996 Issued in RI
Practice address
481 Kingstown Rd
Wakefield, RI 02879-3626
Phone
(401) 789-0283
Fax
(401) 789-0314
NPI assigned
Aug 13, 2006
Last updated
Jul 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD16996 RI Primary

Addresses

Primary practice location

481 Kingstown Rd
Wakefield, RI 02879-3626

Mailing address

481 Kingstown Rd
Wakefield, RI 02879-3626
Phone (401) 789-0283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, RI2 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
I20091222000379 CT Practitioner - Internal Medicine 9436299559 Reassigns benefits to 1 organization
I20200812001070 RI Practitioner - Internal Medicine 9436299559

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD16996RIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Physicians PC Internal Medicine CurrentSince Jun 1, 1997 Accepting new patients

Locations

3 Farm Glen Blvd
Farmington, CT 06032
Phone (860) 284-5200

4 Farm Springs Rd
Farmington, CT 06032
Phone (860) 284-5200

1260 Silas Deane Hwy
Ste 103
Wethersfield, CT 06109
Phone (860) 529-6218

115 Spencer St
Winsted, CT 06098
Phone (860) 738-5810

Interoperability endpoints

  • Direct secure messaging: johnmullaney@scim.allscriptsdirect.net

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1669484929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 KINGSTOWN RD",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028793626",
            "telephone_number": "401-789-0283",
            "fax_number": "401-789-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 KINGSTOWN RD",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028793626",
            "telephone_number": "401-789-0283",
            "fax_number": "401-789-0314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLANEY",
        "first_name": "JOHN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD16996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, RI

Sources for this page

Verify at the official NPI Registry.