J Mullally MD PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

J MULLALLY MD PLLC

Practice address

1117 Stone St
Suite 2
Port Huron, MI 48060-3525

Phone

(810) 966-4540

NPI assigned

Oct 5, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Beth A Noble

Title

Office Manager

Phone

(810) 966-4540

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Patrick Mullally, MD

  • Family Medicine Physician
  • Port Huron, MI
  • NPI 1033105630
  Medicare reassignment NPD

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1699084889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 STONE ST",
            "address_2": "SUITE 2",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603525",
            "telephone_number": "810-966-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 STONE ST",
            "address_2": "SUITE 2",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603525",
            "telephone_number": "810-966-4540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J MULLALLY MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-05",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "NOBLE",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "810-966-4540",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inspired by Jen
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• Jennifer Jackson
• Julia Jackson
• Paul Jacobs
• Jane C Jacobson, C.R.N.A.

• Family Medicine Physician in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.