Mallory Hannah Salentine, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

62745-20 Issued in WI

Practice address

8375 S Howell Ave
Oak Creek, WI 53154-8344

Phone

(414) 764-5726

Fax

(414) 764-6954

NPI assigned

Mar 24, 2013

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

Other identifiers 1

Other names 1

• Mallory Hannah Cohen Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mcohen6903@direct.chw.org

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

• Children'S Medical Group

  • Pediatrics Physician
  • Glendale, WI
  • NPI 1134394471
  NPD (past)

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

{
    "created_epoch": "1364083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1033451455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8375 S HOWELL AVE",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531548344",
            "telephone_number": "414-764-5726",
            "fax_number": "414-764-6954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALENTINE",
        "first_name": "MALLORY",
        "middle_name": "HANNAH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-24",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "62745-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033451455",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "COHEN",
            "middle_name": "HANNAH",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jori Lee Russ, RN
• Zainab Saddiq, OD
• Safetrans LLC
• Dania Saleem, RPH
• Ehsan Saleki, D.D.S
• Natasha Idalys Sanchez
• Uma Y Sanzgiri
• Kathryn S Sayers, LPC
• Michael Scerpella, MD
• Deborah Lau Schingen

• Pediatrics Physician in Oak Creek, WI
• Providers in Oak Creek, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.