MATTHEW RYAN MCMULLAN MD
NPI 1194475558
Student in an Organized Health Care Education/Training Program in Jackson, MS

Q: What is Matthew Mcmullan's NPI number?

The NPI number for Matthew Mcmullan is 1194475558. It was assigned to this individual provider in the NPPES registry on March 28, 2022.

Q: What is Matthew Mcmullan's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Matthew Mcmullan was last updated on March 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 28, 2022PECOS Enrolled

2500 N STATE ST, JACKSON, MS 39216(601) 984-1000 Get Directions Write a Review

NPPES record last updated: March 28, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Matthew Ryan Mcmullan Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MATTHEW RYAN MCMULLAN MD (NPI 1194475558) is an individual student in an organized health care education/training program in Jackson, Mississippi and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1194475558

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameMATTHEW RYAN MCMULLANCredential: MD

Location Address2500 N STATE STJackson, MS 39216-4500

Mailing Address5266 Saratoga DrJackson, MS 39211-4109 · (769) 232-0949

Phone(601) 984-1000

Sole ProprietorNo

Enumeration DateMarch 28, 2022

NPPES CertifiedMarch 28, 2022

✔ NPI 1194475558 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

2500 N STATE ST, Jackson, MS 39216

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Matthew Ryan Mcmullan Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAMAR DAVIS II M.D.

Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology)