Shane R Mull, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23962 Issued in SC

Practice address

3209 Colonial Dr
Usc- Family & Preventive Medicine
Columbia, SC 29203-6930

Phone

(803) 434-6113

Fax

(803) 434-7231

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Medcare Express - North Charleston LLC

  dba Medcare Urgent Care

  • Urgent Care Clinic/Center
  • Charleston, SC
  • NPI 1457579617
  Medicare reassignment NPD
• Medcare Urgent Care Center - Anderson LLC

  • Urgent Care Clinic/Center
  • Anderson, SC
  • NPI 1689004095
  NPD

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427328000000",
    "number": "1699786079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 WESTLAKE FARMS DR",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290168325",
            "telephone_number": "803-917-9333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3209 COLONIAL DR",
            "address_2": "USC- FAMILY & PREVENTIVE MEDICINE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036930",
            "telephone_number": "803-434-6113",
            "fax_number": "803-434-7231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULL",
        "first_name": "SHANE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2015-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "23962",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "23962",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2009-01329",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LL4378",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Joseph Mulherin, MD
• Morgan Muli
• Neelam Jittin Mulji, MD
• Malissa Ann Mulkey, PHD, APRN, CCNS
• Melissa Dawn Mull, FNP
• Stephen Mullaney, APN
• Aquriya S Muller I
• Laura Muller, LMT
• Lessie Lenora Muller
• Tara L Muller, APRN

• Family Medicine Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.