NPIMap

Individual provider Active NPI

Matthew Mullen, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Westbrook, ME
National Provider Identifier
1780358929
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95017939 Issued in CA
Practice address
950 Main St
Westbrook, ME 04092-3067
Phone
(207) 517-3800
Fax
(207) 517-3819
NPI assigned
Aug 2, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95017939 CA Primary

Addresses

Primary practice location

950 Main St
Westbrook, ME 04092-3067

Mailing address

360 US Highway 1 Byp Unit 102
Portsmouth, NH 03801-7105
Phone (603) 410-6700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, ME2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211008002708 CA Practitioner - Nurse Practitioner 7012315856 Reassigns benefits to 2 organizations
I20241023001588 ME Practitioner - Nurse Practitioner 7012315856 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy HospitalGroup PAC ID 6103737812, 307 clinicians

Practice addresses (Care Compare)

225 Gorham Rd
Suite 303
South Portland, ME 04106-2462
Phone (207) 535-1880

Hospital & facility affiliations

  • Northern Light Mercy Hospital Hospital, Portland, ME, CCN 200008
  • Mainehealth Maine Medical Center Hospital, Portland, ME, CCN 200009

Merit-based Incentive Payment System (MIPS)

Final score
95.71 of 100Reported as apm
Quality
89.85
Promoting interoperability
94.05
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95017939CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tahoe Carson Valley Medical Group Inc CurrentSince Oct 1, 2021 Accepting new patients
Barton Medical Foundation CurrentSince Jan 1, 2023 Accepting new patients
Mercy Hospital CurrentSince Aug 24, 2025 Accepting new patients
Convenientmd - FFS UC LLC CurrentSince Nov 1, 2024 Accepting new patients
Mercy Hospital CurrentSince Aug 24, 2025 Accepting new patients
Convenientmd - FFS UC LLC Current Accepting new patients
Convenientmd - FFS UC LLC CurrentSince Nov 1, 2024 Accepting new patients

Locations

2201 South Ave
South Lake Tahoe, CA 96150
Phone (530) 543-5550

1090 3rd St
South Lake Tahoe, CA 96150
Phone (530) 543-5660

2170 South Ave
South Lake Tahoe, CA 96150
Phone (530) 541-3420

2074 Lake Tahoe Blvd
Ste 4
South Lake Tahoe, CA 96150
Phone (530) 543-5554

600 Center St
Auburn, ME 04210
Phone (207) 783-8951

193 Bath Rd
Brunswick, ME 04011
Phone (207) 424-2272

235 High St
Ellsworth, ME 04605
Phone (207) 412-5200

225 Gorham Rd
Ste 303
South Portland, ME 04106
Phone (207) 535-1880

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

950 Main St
Westbrook, ME 04092
Phone (207) 517-3800

360 US Highway 1 Byp
Unit 102
Portsmouth, NH 03801
Phone (603) 410-6700

Organizations & group practices 7

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 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1780358929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 US HIGHWAY 1 BYP UNIT 102",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017105",
            "telephone_number": "603-410-6700",
            "fax_number": "603-319-8308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 MAIN ST",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040923067",
            "telephone_number": "207-517-3800",
            "fax_number": "207-517-3819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "MATTHEW",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-02",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95017939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westbrook, ME

Sources for this page

Verify at the official NPI Registry.