Mallory Gibbons, N.P.

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

RN2269601 Issued in MA

Practice address

21 Eastern Ave
Worcester, MA 01605-3094

Phone

(508) 556-0223

NPI assigned

Jan 11, 2017

Last updated

Apr 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

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

Nurse Practitioner

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Vascular Care Group LLCGroup PAC ID 2769871078, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2915/brand/1/csg/21/fhir/r4

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.

• Vascular Care Group LLC

  • Vascular Surgery Physician
  • Hyannis, MA
  • NPI 1538775481
  Medicare reassignment Care Compare group NPD
• Umass Memorial Medical Center, Inc.

  • Psychiatric Hospital Unit
  • Worcester, MA
  • NPI 1689760092
  Medicare reassignment NPD
• Umass Memorial Medical Group Inc

  • Internal Medicine Physician
  • Worcester, MA
  • NPI 1760445373

  Nurse Practitioner

  Medicare reassignment NPD
• Umass Memorial Medical Group, Inc.

  dba Urgent Care Express at Harrington

  • Urgent Care Clinic/Center
  • Oxford, MA
  • NPI 1982381018
  NPD
• Stephen J. Hoenig, MD, PC

  • Vascular Surgery Physician
  • Leominster, MA
  • NPI 1578561569
  NPD (past)

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

• Umass Memorial Medical Center, Inc.

  • General Acute Care Hospital
  • Worcester, MA
  • NPI 1831151455
  Care Compare affiliation

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1083150361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 EASTERN AVE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053094",
            "telephone_number": "508-556-0223",
            "fax_number": "774-420-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 EASTERN AVE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053094",
            "telephone_number": "508-556-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "MALLORY",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-11",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2269601",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MA",
            "license": "RN2269601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110121244A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frederick Joseph Giarrusso, DDS
• Lisa Marie Giarrusso, D.M.D.
• Alexis Gibbons
• Ashley Elizabeth Gibbons
• Dylan Gibbons
• Patric William Gibbons, MD
• Angel Gibbs
• Dianna M. Gibbs, CRNA
• Kassandra Gibbs
• Susan Gibbs

• Acute Care Nurse Practitioner in Worcester, MA
• Providers in Worcester, MA by specialty
• Acute Care Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.