Brett Justin Mollard, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

4301098145 Issued in MI

Practice address

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Phone

(616) 363-7272

Fax

(616) 361-5828

NPI assigned

Mar 24, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA, NY2 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

Specialty

Diagnostic RadiologyAlso: Nuclear Medicine

Education

Wayne State University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Southside Faculty Medical Affiliates University Faculty Practice CorpGroup PAC ID 5698175933, 224 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
• North Shore University Hospital Hospital, Manhasset, NY, CCN 330106
• Long Island Jewish Medical Center Hospital, New Hyde Park, NY, CCN 330195
• NS/Lij HS Southside Hospital Hospital, Bay Shore, NY, CCN 330043
• NS/Lij HS Huntington Hospital Hospital, Huntington, NY, CCN 330045

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: brett.mollard.p42@direct.proliance.nextgenshare.com
• Direct secure messaging: bmollard68657@northwell.direct-ci.com

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572

  WA

  Medicare reassignment Care Compare group NPD
• Southside Faculty Medical Affiliates University Faculty Practice Corp

  • Body Imaging Physician
  • Seaford, NY
  • NPI 1033791058

  WA

  Medicare reassignment Care Compare group NPD
• Proliance Surgeons Inc P S

  • Orthopaedic Surgery Physician
  • Seattle, WA
  • NPI 1023170313
  Medicare reassignment NPD
• Tra-Minw P S

  • Radiology Clinic/Center
  • Tacoma, WA
  • NPI 1396814166
  Medicare reassignment
• Proliance Surgeons Inc P S

  • Orthopaedic Surgery Physician
  • Renton, WA
  • NPI 1235091463
  NPD
• Proliance Surgeons, Inc., P.S.

  • Otolaryngology Physician
  • Bellevue, WA
  • NPI 1255500542
  NPD
• Tra-Minw P S

  • Radiology Clinic/Center
  • Federal Way, WA
  • NPI 1184790032
  NPD

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

• Huntington Hospital Association

  • General Acute Care Hospital
  • Huntington, NY
  • NPI 1508845322
  Care Compare affiliation
• John T. Mather Memorial Hospital

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1093718728
  Care Compare affiliation
• Long Island Jewish Medical Center

  • General Acute Care Hospital
  • New Hyde Park, NY
  • NPI 1285641514
  Care Compare affiliation
• North Shore University Hospital

  • General Acute Care Hospital
  • Manhasset, NY
  • NPI 1366459570
  Care Compare affiliation
• South Shore University Hospital

  • General Acute Care Hospital
  • Bay Shore, NY
  • NPI 1457369381
  Care Compare affiliation

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

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1669796223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272",
            "fax_number": "616-361-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272",
            "fax_number": "616-361-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLARD",
        "first_name": "BRETT",
        "middle_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-24",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD60646257",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301098145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2058603",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alvonte Molet
• Rosette Nsenga Molin, LLPC
• Adriana Molina-Schmuker, LLMSW
• Orea J Molina
• Ashura Molla, MD
• Sara Jayne Mollema, LMSW
• Adam Mollhagen, LLC
• Charles Thomas Mollien, PHARM.D.
• Catherine Molnar, DO
• Christin Marie Molnar, PHARMD

• Diagnostic Radiology Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Diagnostic Radiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.