Anthony A. Mazzarulli, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

C147508 Issued in CA

Practice address

1601 Cummins Dr Ste D
Modesto, CA 95358-6411

Phone

(510) 900-3125

NPI assigned

Jun 12, 2007

Last updated

Jul 20, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in WI

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

Merit-based Incentive Payment System (MIPS)

Final score

78.61 of 100Reported as group

Quality

58.7

Improvement activities

40

Cost

75.08

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amazzarulli60074@unitedregional.medalliesdirect.net
• FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
• FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/

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.

• Mental Health Emergency Center, Inc.

  • Psychiatric Hospital
  • Milwaukee, WI
  • NPI 1255099941
  Medicare reassignment NPD
• United Regional Health Care System Inc

  dba United Regional Heath Care System

  • General Acute Care Hospital
  • Wichita Falls, TX
  • NPI 1023013448
  NPD
• Carolinas Medical Center

  • General Acute Care Hospital
  • Charlotte, NC
  • NPI 1295789907
  NPD (past)
• Emergency Psychiatric Medicine, PLLC

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1558538520
  NPD (past)

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1801090006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CUMMINS DR STE D",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953586411",
            "telephone_number": "510-900-3125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 CUMMINS DR STE D",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953586411",
            "telephone_number": "510-900-3125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZARULLI",
        "first_name": "ANTHONY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "C147508",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NC",
            "license": "2010-02091",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD180163",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "M6752",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2010-02091",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C147508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194605502",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INSTITUTIONAL PERMIT",
            "identifier": "BP1-0026742",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NC1329",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801090006",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916730",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Wayne Mayhan, ATS
• Tyler S Maynard
• Anthony Mayorga
• Kurt Demetrius Mays
• Shynice Carmel Mays
• Danira Mazzocco Vargas
• Ebele Oyibo Mbeledogu, DNP,FNP-BC, PMHNP-BC
• John Mbeo
• Perla Tshibola Mbumba
• Brian T MC Caffrey, M.D.

• Psychiatry Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.
• 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.