Mallory Elizabeth Boggs, A-GNP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

903821 Issued in MS

Practice address

159 Fountains Blvd Ste B
Madison, MS 39110-6344

Phone

(601) 859-8200

NPI assigned

Mar 19, 2020

Last updated

Mar 19, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS, TX2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fountains of Richmond LLCGroup PAC ID 6709310568, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: malloryboggs@vitalcarems.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fountains of Richmond, LLC

  • Infusion Therapy Clinic/Center
  • Richmond, TX
  • NPI 1336960749
  Medicare reassignment Care Compare group NPD
• Fountains Infusion Center LLC

  • Infusion Therapy Clinic/Center
  • Madison, MS
  • NPI 1467016931
  Medicare reassignment NPD
• Atticus Group LLC

  dba Vital Care of Central Mississippi

  • Home Infusion Therapy Pharmacy
  • Madison, MS
  • NPI 1679910269
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1013543388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 BLACKSTONE CIR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390478808",
            "telephone_number": "601-720-9845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 FOUNTAINS BLVD STE B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106344",
            "telephone_number": "601-859-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGGS",
        "first_name": "MALLORY",
        "middle_name": "ELIZABETH",
        "credential": "A-GNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-19",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "903821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "malloryboggs@vitalcarems.com",
            "affiliation": "N",
            "address_1": "159 Fountains Blvd Ste B",
            "city": "Madison",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391106344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Arianna Leigh Bierdeman, R.D.
• Takinya Raneese Binion Minor, NP
• Bruce T Black, M.D.
• Jessi Jones Blissett, COTA/L
• Bluehealth Baptist, LLC
• Charmaine Bolden
• Kyskie Bolton, RD
• Rachel Roberts Bomgaars, BSN, RN, SNM, SWHNP
• Rachel Bradshaw, PT
• Alyssa Brailsford, DDS

• Primary Care Nurse Practitioner in Madison, MS
• Providers in Madison, MS by specialty
• Primary Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.