Active NPI
Thomas Malott, PA
- Physician Assistant
- Peru, IN
National Provider Identifier
1114982386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10000716A
- Practice address
- 285 W 12TH St
Ste 112
Peru, IN 46970-1653 - Phone
- (765) 475-2388
- NPI assigned
- Apr 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10000716A | IN | Primary |
Addresses
Primary practice location
285 W 12TH St
Ste 112
Peru, IN 46970-1653
Mailing address
285 W 12TH St
Ste. 103
Peru, IN 46970-1653
Phone (765) 475-2316
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10000716A | IN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332806400000",
"number": "1114982386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "285 W 12TH ST",
"address_2": "STE. 103",
"city": "PERU",
"state": "IN",
"postal_code": "469701653",
"telephone_number": "765-475-2316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "285 W 12TH ST",
"address_2": "STE 112",
"city": "PERU",
"state": "IN",
"postal_code": "469701653",
"telephone_number": "765-475-2388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALOTT",
"first_name": "THOMAS",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-19",
"last_updated": "2012-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "10000716A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peru, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.