Individual provider Active NPI

Mallory Krzys, PA-C

  • Physician Assistant
  • Geneva, OH
National Provider Identifier
1053035956
Registry record updated Dec 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1028 S Broadway
Geneva, OH 44041-7124
Phone
(647) 705-1655
NPI assigned
Oct 4, 2022
Last updated
Dec 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary
Family Medicine Physician 207Q00000X 50.007819RX OH

Addresses

Primary practice location

1028 S Broadway
Geneva, OH 44041-7124

Mailing address

4009 Shi Mar Dr
Ashtabula, OH 44004-4640
Phone (440) 813-1579

Other practice location 1

6801 Mayfield Rd
Cleveland, OH 44124-2270
Phone (440) 312-4500

Other practice location 2

4009 Shi Mar Dr
Ashtabula, OH 44004-4640
Phone (440) 813-1579

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20221114002154 OH Practitioner - Physician Assistant 0446627939 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
Cleveland OBGYN LLCGroup PAC ID 0244697423, 2 clinicians
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

1028 S Broadway
Geneva, OH 44041-7124
Phone (647) 705-1655

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-5433

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Cleveland Clinic Foundation Family Medicine CurrentSince Jan 21, 2026 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Jan 21, 2026 Accepting new patients

Locations

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6801 Mayfield Rd
Mayfield Hts, OH 44124
Phone (440) 312-4515

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 3

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": "1664841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765670400000",
    "number": "1053035956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4009 SHI MAR DR",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440044640",
            "telephone_number": "440-813-1579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 S BROADWAY",
            "city": "GENEVA",
            "state": "OH",
            "postal_code": "440417124",
            "telephone_number": "647-705-1655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6801 Mayfield Rd",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441242270",
            "country_code": "US",
            "telephone_number": "440-312-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4009 Shi Mar Dr",
            "address_purpose": "LOCATION",
            "city": "Ashtabula",
            "state": "OH",
            "postal_code": "440044640",
            "country_code": "US",
            "telephone_number": "440-813-1579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRZYS",
        "first_name": "MALLORY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-04",
        "last_updated": "2025-12-14",
        "certification_date": "2025-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "50.007819RX",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, OH

Sources for this page

Verify at the official NPI Registry.