Andrew J Mullally (NPI# 1164860086, PAC ID# 6507080975) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1164860086 |
| PAC ID by PECOS | 6507080975 |
| Professional Enrollment ID | I20140918000377 |
| Full Name | Andrew J Mullally |
| Organization Legal Name | CREDO HEALTH GROUP LLC |
| Address |
10050 Auburn Park Dr Fort Wayne IN 46825-2389 |
| Phone Number | 2604326459 |
| Gender | M |
| Medical School | MICHIGAN STATE UNIVERSITY COLLEGE OF HUMAN MEDICINE |
| Graduation Year | 2013 |
| Primary Specialty | FAMILY MEDICINE |
| Secondary Specialties | EMERGENCY MEDICINE |
| Group Practice PAC ID | 2769775782 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 150021 | PARKVIEW REGIONAL MEDICAL CENTER |
| 150150 | DUPONT HOSPITAL LLC |
| 150045 | DEKALB HEALTH |
| Address | Phone | Organization |
|---|---|---|
| 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 | 2604326459 | CREDO HEALTH GROUP LLC |
| Organization Legal Name | CREDO HEALTH GROUP LLC |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Cassandralee Herber | Nurse Practitioner | Credo Health Group LLC | 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 |
| David J Moran | Family Medicine | Credo Health Group LLC | 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 |
| Nicholas Martin Lesch | Physician Assistant | Credo Health Group LLC | 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 |
| Street Address |
10050 AUBURN PARK DR |
| City | FORT WAYNE |
| State | IN |
| Zip | 46825-2389 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Cassandralee Herber | Nurse Practitioner | Credo Health Group LLC | 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 |
| David J Moran | Family Medicine | Credo Health Group LLC | 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 |
| Nicholas Martin Lesch | Physician Assistant | Credo Health Group LLC | 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Diana M Nguyen | Podiatry | Richard M. Hilker, Dpm, P.C. | 10323 Dawson's Creek Blvd Bldg, 10c, Fort Wayne, IN 46825 |
| David A Campbell | Rheumatology | Parkview Health System Inc | 1234 E Dupont Rd, Suite 5, Fort Wayne, IN 46825-1545 |
| Amie Dent | Registered Dietitian Or Nutrition Professional | Parkview Health System Inc | 1234 E Dupont Rd, Suite 5, Fort Wayne, IN 46825-1545 |
| Michele L Helfgott | Obstetrics/gynecology | Parkview Health System Inc | 1234 E Dupont Rd, Suite 5, Fort Wayne, IN 46825-1545 |
| Wendy Sue Clark | Nurse Practitioner | Parkview Health System Inc | 1234 E Dupont Rd, Suite 5, Fort Wayne, IN 46825-1545 |
| Kim Sue Penland | Nurse Practitioner | Parkview Health System Inc | 1234 E Dupont Rd, Suite 5, Fort Wayne, IN 46825-1545 |
| Moran Muehlmeyer | Nurse Practitioner | Parkview Health System Inc | 1234 E Dupont Rd, Suite 5, Fort Wayne, IN 46825-1545 |
| Karen S Evans | Family Medicine | Parkview Health System Inc | 1234 E Dupont Rd, Suite 5, Fort Wayne, IN 46825-1545 |
| Brooke Elizabeth Bohnstedt | Nurse Practitioner | Parkview Health System Inc | 1234 E Dupont Rd, Suite 5, Fort Wayne, IN 46825-1545 |
| Hirenkumar P Patel | Internal Medicine | Parkview Health System Inc | 1234 E Dupont Rd, Suite 5, Fort Wayne, IN 46825-1545 |
| Find all physicians in zip 46825 | |||
| City | FORT WAYNE |
| Zip Code | 46825 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | FORT WAYNE + FAMILY MEDICINE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.