Individual provider Active NPI

Stephen James Malloney, D.O.

  • Pediatrics Physician
  • Mooresville, NC
National Provider Identifier
1083783245
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2015-01843 Issued in NC
Practice address
134 Medical Park Rd Ste 100
Mooresville, NC 28117-8527
Phone
(704) 662-0106
Fax
(808) 290-6369
NPI assigned
Nov 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 990 SC
Pediatrics Physician 208000000X 2015-01843 NC Primary

Addresses

Primary practice location

134 Medical Park Rd Ste 100
Mooresville, NC 28117-8527

Mailing address

PO Box 1845
Statesville, NC 28687-1845

Other identifiers 1

IdentifierTypeStateIssuer
GP4505MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160307001532 NC Practitioner - Pediatric Medicine 9537349592 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2015-01843NCMDPediatrics Physician
990SCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Healthcare, PA CurrentSince Mar 1, 2016 Accepting new patients
Piedmont Healthcare, P.a. Pediatrics CurrentSince Mar 1, 2016 Accepting new patients

Locations

134 Medical Park Rd
Ste 100
Mooresville, NC 28117
Phone (704) 662-0106

128 Medical Park Rd
Ste 200
Mooresville, NC 28117
Phone (704) 696-2085

208 Old Mocksville Rd
Statesville, NC 28625
Phone (704) 838-8215

650 Signal Hill Drive Ext
Statesville, NC 28625
Phone (704) 873-4277

Interoperability endpoints

  • Direct secure messaging: stephenmalloney@phc.allscriptsdirect.net

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1083783245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1845",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286871845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 MEDICAL PARK RD STE 100",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178527",
            "telephone_number": "704-662-0106",
            "fax_number": "808-290-6369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLONEY",
        "first_name": "STEPHEN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "990",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2015-01843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4505",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.