John Adrian Mulder, MD is a medicare enrolled "Specialist" physician in Grand Rapids, Michigan. His current practice location is
2100 Raybrook St Se, Grand Rapids, Michigan. You can reach out to his office (for appointments etc.) via phone at
(616) 235-5101.
John Adrian Mulder is licensed to practice in Tennessee (license number 34321) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1215985114.
Physician's Profile
Full Name | John Adrian Mulder |
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Gender | Male |
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Speciality | Specialist |
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Location | 2100 Raybrook St Se, Grand Rapids, Michigan |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1215985114
- Provider Enumeration Date: 05/04/2006
- Last Update Date: 06/29/2021
Medicare PECOS Information:
- PECOS PAC ID: 3779529144
- Enrollment ID: I20081013000269
Medical Identifiers
Medical identifiers for John Adrian Mulder such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1215985114 | NPI | - | NPPES |
3863027 | Medicaid | TN | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | 4301043859 (Michigan) | Secondary |
207QH0002X | Family Medicine - Hospice And Palliative Medicine | 4301043859 (Michigan) | Secondary |
174400000X | Specialist | 34321 (Tennessee) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. John Adrian Mulder allows following entities to bill medicare on his behalf.
Entity Name | Metropolitan Hospital |
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Entity Type | Part B Supplier - Hospital Department(s) |
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Entity Identifiers | NPI Number: 1487813200 PECOS PAC ID: 5597651836 Enrollment ID: O20080711000526 |
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Entity Name | Faith Hospice |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1790739282 PECOS PAC ID: 9436102845 Enrollment ID: O20120420000348 |
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Entity Name | Wings Of Hope Hospice And Palliative Care, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1306249073 PECOS PAC ID: 7618114380 Enrollment ID: O20151005000393 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. John Adrian Mulder is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
John Adrian Mulder, MD 600 Broadway Nw #423, Grand Rapids, MI 49504 Ph: (616) 235-5100 | John Adrian Mulder, MD 2100 Raybrook St Se, Grand Rapids, MI 49546-7759 Ph: (616) 235-5101 |
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