NPIMap

Individual provider Active NPI

Mallory B Warren-Brothers, PA-C

  • Physician Assistant
  • Saint Robert, MO
National Provider Identifier
1043925639
Registry record updated Mar 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2023011900 Issued in MO
Practice address
608 Old Route 66
Saint Robert, MO 65584-3730
Phone
(573) 336-5100
NPI assigned
Jan 18, 2023
Last updated
Mar 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiologic Technologist 247100000X 588293 MO
Physician Assistant 363A00000X 2023011900 MO Primary

Addresses

Primary practice location

608 Old Route 66
Saint Robert, MO 65584-3730

Mailing address

608 Old Route 66
Saint Robert, MO 65584-3730
Phone (573) 336-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20230404001727 MO Practitioner - Physician Assistant 0547635617 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1605 Martin Springs Dr
Rolla, MO 65401-2980

608 Old Route 66
Saint Robert, MO 65584-3730

904 S Pine St
MC Family Medicine Richland
Richland, MO 65556-7393
Phone (573) 765-2956

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
588293MOMDRadiologic Technologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Apr 3, 2023 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 3, 2023 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 3, 2023 Accepting new patients

Locations

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

608 Old Route 66
Saint Robert, MO 65584
Phone (573) 336-5100

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Organizations & group practices 3

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1674000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1043925639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 OLD ROUTE 66",
            "city": "SAINT ROBERT",
            "state": "MO",
            "postal_code": "655843730",
            "telephone_number": "573-336-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 OLD ROUTE 66",
            "city": "SAINT ROBERT",
            "state": "MO",
            "postal_code": "655843730",
            "telephone_number": "573-336-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN-BROTHERS",
        "first_name": "MALLORY",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-18",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "MO",
            "license": "588293",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2023011900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Robert, MO

Sources for this page

Verify at the official NPI Registry.