Kelly Louise Mullen
Individual provider Active NPI Family Medicine Physician · North Manchester, IN
NPI 1669992228 · NPPES record last updated Oct 27, 2020
Key facts
- NPI
- 1669992228
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 11019604A (IN)
- Practice address
- 605 N Walnut St
North Manchester, IN 46962-1857 - Phone
- (260) 982-1994
- Fax
- (260) 479-2936
- NPI assigned
- Jun 26, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Osteopathic Manipulative Medicine
- Education
- Marian University College of Osteopathic Medicine, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Vancouver Clinic Inc PS
Practice addresses (Care Compare)
2005 W Main St
Battle Ground, WA 98604-4311
Phone (360) 882-2778
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.99 of 100
- Quality
- 77.41
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- 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 |
|---|---|---|---|---|
| I20240712002223 | WA | Practitioner - Osteopathic Manipulative Medicine | 2769751510 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11019604A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Vancouver Clinic Inc PS | Family Medicine | Current |
Accepting new patients |
| The Vancouver Clinic Inc PS | Current |
Accepting new patients | |
| The Vancouver Clinic Pharmacy | Past | Accepting new patients |
Locations
2005 W Main St
Ste 110
Battle Ground, WA 98604
2005 W Main St
Battle Ground, WA 98604
Phone (360) 604-1600
700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500
Interoperability endpoints
- kmullen24191@tvc-direct.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11019604A | IN | Yes |
Addresses
Primary practice location
605 N Walnut St
North Manchester, IN 46962-1857
Mailing address
6920 Pointe Inverness Way Ste 200
Fort Wayne, IN 46804-7934
Phone (260) 479-3513
Other practice location 1
750 Broadway Ste 350
Fort Wayne, IN 46802-1412
Phone (260) 423-2675
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kelly.mullen@lutheranhealthnetwork.cernerdirect.com |
Other providers in North Manchester, IN
- Manchester Community Schools
- Manchester Eyecare LLC
- Manchester Family Dentistry, PC
- Alison Dael Matheny
- Midwest Eye Consultants, P.C.
- Daniel P Myers
- Natures Remedy LLC
- North Manchester Pharmacies
- Orthopaedics Northeast, PC
- Palladino Enterprises LLC
All providers in North Manchester, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2020. 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.