NPIMap

Individual provider Active NPI

Avi Meir Samuel Mallin, PA-C

  • Physician Assistant
  • Mesa, AZ
National Provider Identifier
1023342813
Registry record updated Jan 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4512 Issued in AZ
Practice address
6644 East Baywood Avenue
Banner Baywood Medical Center
Mesa, AZ 85206
Phone
(480) 321-4740
Fax
(480) 321-4565
NPI assigned
Sep 25, 2009
Last updated
Jan 13, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4512 AZ Primary

Addresses

Primary practice location

6644 East Baywood Avenue
Banner Baywood Medical Center
Mesa, AZ 85206

Mailing address

4838 E Flower St
Phoenix, AZ 85018-6538
Phone (702) 845-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091124000344 AZ Practitioner - Physician Assistant 9335288729 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jonathan S Hott MD PLCGroup PAC ID 0244233542, 28 clinicians

Practice addresses (Care Compare)

1301 E McDowell Rd
Suite 100
Phoenix, AZ 85006-2605
Phone (602) 254-6879

3700 N 24TH St
Suite 210
Phoenix, AZ 85016-6536
Phone (602) 840-0681

4860 E Baseline Rd
Suite 103
Mesa, AZ 85206-4670
Phone (602) 254-6879

8670 E Shea Blvd
Suite 102
Scottsdale, AZ 85260-6656
Phone (602) 840-0681

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Pain Treatment Center P C CurrentSince Oct 18, 2022 Accepting new patients
Scottsdale Emergency Associates, LTD. Physician Assistant CurrentSince Nov 15, 2016 Accepting new patients
Desert Spine and Sports Physicians PLLC Past Accepting new patients
Med 97 LLC Past Accepting new patients
Center for Physical Medicine & Rehabilitation P C Past Accepting new patients

Locations

1301 E McDowell Rd
Ste 100
Phoenix, AZ 85006
Phone (602) 254-6879

8805 N 23rd Ave
Ste 120
Phoenix, AZ 85021
Phone (602) 254-6879

7400 E Osborn Rd
Scottsdale, AZ 85251
Phone (480) 481-4000

Organizations & group practices 12

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1253836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421107200000",
    "number": "1023342813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4838 E FLOWER ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850186538",
            "telephone_number": "702-845-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6644 EAST BAYWOOD AVENUE",
            "address_2": "BANNER BAYWOOD MEDICAL CENTER",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85206",
            "telephone_number": "480-321-4740",
            "fax_number": "480-321-4565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIN",
        "first_name": "AVI",
        "middle_name": "MEIR SAMUEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-25",
        "last_updated": "2015-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.