Individual provider Active NPI

Timothy H Mullinix, CRNP

  • Nurse Practitioner
  • Jackson, AL
National Provider Identifier
1851391817
Registry record updated Mar 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1-064044 Issued in AL
Practice address
227 Hospital Dr
Jackson, AL 36545-2423
Phone
(251) 246-4446
Fax
(251) 246-5111
NPI assigned
Jul 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1-064044 AL Primary

Addresses

Primary practice location

227 Hospital Dr
Jackson, AL 36545-2423

Mailing address

PO Box 639
227 Hospital Drive
Jackson, AL 36545-0639
Phone (251) 246-4446

Other identifiers 1

IdentifierTypeStateIssuer
529700760MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100322000382 AL Practitioner - Nurse Practitioner 1456486034 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of Jackson Healthcare AuthorityGroup PAC ID 2062950199, 16 clinicians
GHS JMC Clinics LLCGroup PAC ID 6800191107, 6 clinicians

Practice addresses (Care Compare)

227 Hospital Dr
Jackson, AL 36545-2423
Phone (251) 246-4446

Hospital & facility affiliations

  • Jackson Medical Center Hospital, Jackson, AL, CCN 010128

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Imc-Family Medical of Jackson, PC Current Accepting new patients
City of Jackson Healthcare Authority CurrentSince Mar 1, 2016 Accepting new patients
Mobile Emergency Physicians, LLC CurrentSince Apr 15, 2013 Accepting new patients
City of Jackson Healthcare Authority CurrentSince Dec 5, 2024 Accepting new patients

Locations

227 Hospital Dr
Jackson, AL 36545
Phone (251) 246-4446

6801 Airport Blvd
Mobile, AL 36608
Phone (251) 266-3580

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • Direct secure messaging: timothy.mullinix@imcfammed.direct.medconnect-inc.com

Organizations & group practices 6

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 1

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": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301529600000",
    "number": "1851391817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "address_2": "227 HOSPITAL DRIVE",
            "city": "JACKSON",
            "state": "AL",
            "postal_code": "365450639",
            "telephone_number": "251-246-4446",
            "fax_number": "251-246-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 HOSPITAL DR",
            "city": "JACKSON",
            "state": "AL",
            "postal_code": "365452423",
            "telephone_number": "251-246-4446",
            "fax_number": "251-246-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINIX",
        "first_name": "TIMOTHY",
        "middle_name": "H",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2011-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-064044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529700760",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, AL

Sources for this page

Verify at the official NPI Registry.