Mallory Jean Henson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085007315 Issued in IL

Practice address

6800 State Route 162 Ste 200
Maryville, IL 62062-8521

Phone

(618) 288-0900

Fax

(618) 288-0909

NPI assigned

Nov 18, 2019

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 names 1

• Mallory Jean Stimac Former name

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Midwest Inpatient Anderson Health IncGroup PAC ID 3072908474, 46 clinicians

Urology of St Louis IncGroup PAC ID 6204723786, 112 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Anderson Hospital Hospital, Maryville, IL, CCN 140289
• HSHS St Elizabeth'S Hospital Hospital, O Fallon, IL, CCN 140187
• St Josephs Hospital Hospital, Breese, IL, CCN 140145
• SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

Merit-based Incentive Payment System (MIPS)

Final score

79.16 of 100Reported as group

Quality

55.68

Promoting interoperability

100

Improvement activities

40

Cost

74.84

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mallorystimac@slus.allscriptsdirect.net

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.

• Midwest Inpatient Anderson Health, Inc

  • Emergency Medicine Physician
  • Maryville, IL
  • NPI 1821758608
  Medicare reassignment Care Compare group
• Urology of St. Louis, Inc.

  • Specialist
  • Saint Louis, MO
  • NPI 1528017191

  IL

  Medicare reassignment Care Compare group
• Midwest Emergency Anderson Health, Inc

  • Emergency Medicine Physician
  • Staunton, IL
  • NPI 1710647615
  Medicare reassignment
• Urology of St. Louis, Inc.

  • Specialist
  • O Fallon, IL
  • NPI 1265392476
  NPD

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

• Anderson Hospital

  • General Acute Care Hospital
  • Maryville, IL
  • NPI 1053481630
  Care Compare affiliation
• St Elizabeths Hospital of the Hospital Sisters of the Third Order

  • General Acute Care Hospital
  • O Fallon, IL
  • NPI 1629057302
  Care Compare affiliation
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde

  • Rural Health Clinic/Center
  • Breese, IL
  • NPI 1013002658

  Hospital

  Care Compare affiliation
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde

  • General Acute Care Hospital
  • Breese, IL
  • NPI 1457319154
  Care Compare affiliation
• SSM Select Rehab St Louis LLC

  • Rehabilitation Hospital
  • Richmond Heights, MO
  • NPI 1659511988

  Inpatient rehabilitation facility

  Care Compare affiliation

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

{
    "created_epoch": "1574035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1043856701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12855 N 40 DR STE 375",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418657",
            "telephone_number": "314-567-6071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 STATE ROUTE 162 STE 200",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628521",
            "telephone_number": "618-288-0900",
            "fax_number": "618-288-0909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "326 Fountains Pkwy",
            "address_purpose": "LOCATION",
            "city": "Fairview Heights",
            "state": "IL",
            "postal_code": "622082041",
            "country_code": "US",
            "telephone_number": "618-277-3109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3 Saint Elizabeth Blvd Ste 3200",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622691281",
            "country_code": "US",
            "telephone_number": "618-489-8030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Memorial Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Alton",
            "state": "IL",
            "postal_code": "620026723",
            "country_code": "US",
            "telephone_number": "618-288-0900",
            "fax_number": "618-288-0909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENSON",
        "first_name": "MALLORY",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-18",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085007315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "STIMAC",
            "middle_name": "JEAN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Lynn Hemann, LCSW
• Rafe M Heng, D.O., FACC
• Mary Martin Henry, M.D.
• Adrian Lynn Henson
• Daniel Henson, RN
• Kort Herman, DMD
• Diana Lynn Herrick, CNM
• Dereck Hill, DMD
• Justin Bradley Hill, M.D.
• Thomas E Hill, MD

• Physician Assistant in Maryville, IL
• Providers in Maryville, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; 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.