NPIMap

Individual provider Active NPI

Sean E Mullen, D.O.

  • Diagnostic Radiology Physician
  • Albuquerque, NM
National Provider Identifier
1710981410
Registry record updated Oct 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A-1171-01 Issued in NM
Practice address
4411 The 25 Way NE
Ste 150
Albuquerque, NM 87109-5888
Phone
(505) 332-6900
Fax
(505) 332-6921
NPI assigned
Jun 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A-1171-01 NM Primary

Addresses

Primary practice location

4411 The 25 Way NE
Ste 150
Albuquerque, NM 87109-5888

Mailing address

4411 The 25 Way NE
Ste 150
Albuquerque, NM 87109-5888
Phone (505) 332-6900

Other identifiers 5

IdentifierTypeStateIssuer
2258272OtherNMMEDICARE GROUP
52713MedicaidNM
45138MedicaidNM
71880321MedicaidNM
L0634MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20041011000229 NM Practitioner - Diagnostic Radiology 2365401072 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Ohio Medical University, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

8713 Royal Glo Dr NE
Albuquerque, NM 87122-4338
Phone (800) 841-4236

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.28 of 100Reported as group
Quality
90
Improvement activities
40
Cost
77.05

Merit-based Incentive Payment System (MIPS)

Final score
91.5 of 100Reported as group
Quality
90
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Imaging LLC Diagnostic Radiology CurrentSince May 1, 2007 Accepting new patients
East Georgia Regional Medical Center, LLC Past Accepting new patients
Lagrange Troup County Hospital Authority Past Accepting new patients

Locations

2400 Unser Blvd SE
Ste 29200
Albuquerque, NM 87124

4411 The 25 Way NE
Ste 150
Albuquerque, NM 87109
Phone (505) 332-5800

Organizations & group practices 4

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.

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192665600000",
    "number": "1710981410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 THE 25 WAY NE",
            "address_2": "STE 150",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095888",
            "telephone_number": "505-332-6900",
            "fax_number": "505-332-6921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 THE 25 WAY NE",
            "address_2": "STE 150",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095888",
            "telephone_number": "505-332-6900",
            "fax_number": "505-332-6921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "SEAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2007-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NM",
            "license": "A-1171-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "2258272",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52713",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45138",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71880321",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L0634",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.