NPIMap

Individual provider Active NPI

Tracy E Mallory, PA-C

  • Physician Assistant
  • Orland Park, IL
National Provider Identifier
1083281653
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.008358 Issued in IL
Practice address
15300 West Ave Ste 100a
Orland Park, IL 60462-4600
Phone
(708) 226-2318
Fax
(708) 226-2319
NPI assigned
Jun 10, 2021
Last updated
Sep 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.008358 IL Primary

Addresses

Primary practice location

15300 West Ave Ste 100a
Orland Park, IL 60462-4600

Mailing address

15300 West Ave Ste 100a
Orland Park, IL 60462-4600
Phone (708) 226-2318

Other names 1

  • Tracy E Korn Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20230515002736 IL Practitioner - Physician Assistant 7012373178 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

15300 W Ave
Orland Park, IL 60462-4600

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.008358ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Partners,Inc CurrentSince May 22, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 8, 2025 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 8, 2025 Accepting new patients
Adventist Health Partners, Inc CurrentSince May 22, 2023 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

396 Remington Blvd
Ste 231
Bolingbrook, IL 60440
Phone (630) 312-4301

Dept 5777
Carol Stream, IL 60122

908 N Elm St
Ste 210
Hinsdale, IL 60521
Phone (630) 654-1790

660 N Westmoreland Rd
Lake Forest, IL 60045
Phone (847) 535-6100

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

15300 West Ave
Ste 100A
Orland Park, IL 60462
Phone (708) 226-2318

Organizations & group practices 6

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 8

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": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1083281653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15300 WEST AVE STE 100A",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624600",
            "telephone_number": "708-226-2318",
            "fax_number": "708-226-2319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15300 WEST AVE STE 100A",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624600",
            "telephone_number": "708-226-2318",
            "fax_number": "708-226-2319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "TRACY",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-10",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.008358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "KORN",
            "middle_name": "E",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orland Park, IL

Sources for this page

Verify at the official NPI Registry.