NPIMap

Individual provider Active NPI

Mark Jay Mullen, MD

  • Internal Medicine Physician
  • Feasterville Trevose, PA
National Provider Identifier
1679581870
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD0402071E Issued in PA
Practice address
23 Bustleton Pike
Suite 200
Feasterville Trevose, PA 19053-6446
Phone
(215) 464-0770
Fax
(267) 579-0720
NPI assigned
Aug 3, 2006
Last updated
Jul 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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 MD0402071E PA Primary

Addresses

Primary practice location

23 Bustleton Pike
Suite 200
Feasterville Trevose, PA 19053-6446

Mailing address

1648 Huntingdon Pike
Medical Staff Office 1St FLR
Meadowbrook, PA 19046-8001
Phone (215) 938-3450

Other names 1

  • Dr. Mark Jay Mullen Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111020000460 PA Practitioner - Internal Medicine 4880670199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
HR Physician ServicesGroup PAC ID 0042109902, 188 clinicians

Practice addresses (Care Compare)

23 Bustleton Pike
Feasterville Trevose, PA 19053-6446

8580 Verree Rd
Philadelphia, PA 19111-1370
Phone (215) 436-1420

910 2ND St Pike
Richboro, PA 18954-1527
Phone (215) 436-1420

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD0402071EPAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
HR Physician Services Internal Medicine CurrentSince Jan 1, 2013 Accepting new patients
HR Physician Services Internal Medicine CurrentSince Jan 1, 2013 Accepting new patients
HR Physician Services Internal Medicine Current Accepting new patients
Carl Rosenbaum MD PC Internal Medicine PastSince Nov 21, 2002 Accepting new patients
Holy Redeemer Health System Past Accepting new patients
HR Physician Services Past Accepting new patients

Locations

23 Bustleton Pike
Ste 200
Feasterville Trevose, PA 19053
Phone (215) 464-0770

1648 Huntingdon Pike
Fl 1
Meadowbrook, PA 19046
Phone (215) 938-2040

1648 Huntingdon Pike
Ofc 1ST
Meadowbrook, PA 19046

10160 Bustleton Ave
Ste A
Philadelphia, PA 19116
Phone (215) 364-0777

Interoperability endpoints

  • Direct secure messaging: mark.mullen.1@17399.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Holy Redeemer Diabetes CounselingDarby, PA, CCN 395821 Skilled nursing facility Corporate Director Dec 15, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 6

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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1679581870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1648 HUNTINGDON PIKE",
            "address_2": "MEDICAL STAFF OFFICE 1ST FLR",
            "city": "MEADOWBROOK",
            "state": "PA",
            "postal_code": "190468001",
            "telephone_number": "215-938-3450",
            "fax_number": "215-938-3829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 BUSTLETON PIKE",
            "address_2": "SUITE 200",
            "city": "FEASTERVILLE TREVOSE",
            "state": "PA",
            "postal_code": "190536446",
            "telephone_number": "215-464-0770",
            "fax_number": "267-579-0720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "MARK",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2021-07-01",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD0402071E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "MULLEN",
            "middle_name": "JAY",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Feasterville Trevose, PA

Sources for this page

Verify at the official NPI Registry.