J MULLALLY MD PLLC
NPI 1699084889
Family Medicine in Port Huron, MI
About J Mullally Md Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
J MULLALLY MD PLLC (NPI 1699084889) is a healthcare organization registered as a family medicine in Port Huron, Michigan and active in the NPI registry since October 2010. The organization holds a CLIA Microscopy certificate valid through October 25, 2027 and lists Beth A Noble, Office Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
J Mullally Md Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to J Mullally MD PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate for Provider-Performed Microscopy Procedures (PPMP) 23D0992827
J Mullally MD PLLC · Port Huron, MIFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is J Mullally MD PLLC's NPI number?
The NPI number for J Mullally MD PLLC is 1699084889. It was assigned to this organization in the NPPES registry on October 5, 2010.
Where is J Mullally MD PLLC located?
J Mullally MD PLLC is located at 1117 Stone St Suite 2, Port Huron, MI 48060. The listed phone number is (810) 966-4540.
What is J Mullally MD PLLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is J Mullally MD PLLC enrolled in Medicare?
Yes. J Mullally MD PLLC is registered in the Medicare PECOS enrollment system.
When is J Mullally MD PLLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Michigan, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through J Mullally MD PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to J Mullally MD PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does J Mullally MD PLLC hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 23D0992827) is associated with this NPI, valid through October 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does J Mullally MD PLLC accept?
Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian and Blue Cross Blue Shield of Michigan Mutual Insurance Company list J Mullally MD PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for J Mullally MD PLLC was last updated on October 5, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# J Mullally Md Pllc · NPI 1699084889
Family Medicine organization in Port Huron, Michigan. Organization record, active in the CMS NPPES registry since October 5, 2010.
## Identity
- **NPI:** 1699084889 (Entity type: Organization)
- **Enumerated:** October 5, 2010
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Beth Noble, OFFICE MANAGER
## Practice location
- **Address:** 1117 STONE ST, SUITE 2, Port Huron, MI 48060-3525
- **Phone:** (810) 966-4540
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, Michigan, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 5, 2010
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1699084889) · Data from the CMS NPPES public registry.